Engeriedspital

D ie American Society of Clinical Oncology (ASCO) ist eine interdisziplinäre Fachgesellschaft, die sich neben der medikamentösen Tumortherapie auch mit Diagnostik, Chirurgie und Radiotherapie von malignen Erkrankungen befasst. Die ASCO hat 2012 im Rahmen der Initiative «Choosing Wisely» eine «top-5-list in oncology» publiziert (Choosing Wisely | ASCO) [1]. Darin rät sie in bestimmten Situationen wegen mangelnden klinischen Nutzens von gewissen Behandlungen, Bildgebungen und Laboruntersuchungen ab. Die Liste richtet sich an Fachpersonal und Betroffene und wurde 2021 um fünf weitere Empfehlungen erweitert. Auf smartermedicine.ch haben andere Schweizer Fachgesellschaften (Chirurgie und Radioonkologie) bereits Empfehlungen über Tumortherapien aus ihren jeweiligen Fachgebieten publiziert. Auf Initiative der Medizinischen Onkologie am Luzerner Kantonsspital (LUKS) hat der Vorstand der Schweizerischen Gesellschaft für Medizinische Onkologie (SGMO) 2022 einer Adaptation der Top-5-Liste der ASCO zugestimmt. Gemeinsam mit den Initianten des Top-5-Liste Medizinische Onkologie Empfehlungen smarter medicine publiziert in Zusammenarbeit mit der Schweizerischen Gesellschaft für Medizinische Onkologie eine Top-5-Liste. Darin sind fünf unnötige Behandlungen sowie Abklärungsschritte aufgeführt, auf die verzichtet werden kann. Ziel ist es, die Kosten zu reduzieren und den Patientinnen und Patienten einen Mehrwert zu bieten.

Die Epidemiologie beschreibt Krankheitshaufigkeiten in Bevolkerungsgruppen, ihre Veranderungen im Verlauf der Zeit sowie Unterschiede bedingt durch Alter, Geschlecht, Beruf und andere Faktoren. Maszahlen der Epidemiologie wie Inzidenz, Mortalitat und Uberlebensraten werden erlautert. Die Epidemiologie der Tumorerkrankungen liefert Hinweise auf Risikofaktoren, die die Entstehung von Krebserkrankungen beeinflussen. Beeinflussbare und nicht beeinflussbare Risikofaktoren werden diskutiert, darunter Rauch- und Ernahrungsgewohnheiten, Ubergewicht, Infektionen, Strahlung, Vererbung u.a.m.

Abstract Background: The SentiMag study compares the “gold standard” 99mTc with a new technique, which employs superparamagnetic iron oxide particles (SPIO) for localization of sentinel lymph nodes. Aim of this study is to investigate the potential equivalency of the SentiMag® technique in comparison to the gold standard of sentinel lymph node biopsy (SLNB). Materials and methods: In a prospective, multicentre and multinational 2-arm study, 150 patients with histologically verified breast carcinoma are examined. For comparison, SLNs are marked initially with radioisotope following a 1- or 2-day protocol. Additionally, SPIO (Sienna+®) is injected in the operation room by the surgeon at least 20 minutes before SLNB into the subareolar interstitial tissue, followed by 5 minutes massage. SLN-detection is carried out using a magnetometer (SentiMag®) and a gamma probe. Preparation and excision of lymph nodes is conducted using both techniques in a parallel manner. All lymph nodes marked with either tracer are excised. Results: Interim analysis of 138 patients resulted in a detection rate concordance per patient of 97% (134/138). An average of 1.9 (radioisotope) and 2.0 (SPIO) lymph nodes were collected per patient. Nodal detection rate was 92% (250/273) for the radioisotope vs. 97% (265/273) for the SPIO tracer with magnetometer detection. The proportion of pathologically positive lymph nodes was 38/250 (15%) vs. 39/265 (15%) for the radioisotope and the SPIO tracer respectively. All pathologically positive lymph nodes detected with the conventional technique (radioisotope) were also detected with the new technique (SentiMag®). Conclusions: The SentiMag® provides an easy technique which can be rapidly implemented into daily routine. Due to the simple handling, preoperative efforts can be reduced to a minimum. If further and consistent results prove its efficacy, this technique may ultimately replace the standard of care. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-02.

It is currently estimated that 25-30% of all breast cancers have a familial background. The breast cancer lifetime risk of first degree relatives with a family history of breast cancer may be classified as slightly, moderately or highly increased above the population risk. Individuals from families with a highly increased risk for breast cancer should be offered genetic counselling and testing. Here, the elements of genetic counselling and testing and the management of families with a highly increased breast and ovarian risk will be discussed.

Subjective well-being is a major aspect of quality of life and is therefore increasingly used as an endpoint in clinical trials. It is influenced to a great extent by the complex process of coping with the disease and its treatment. Assessment of coping is methodologically demanding, especially in large clinical trials. We therefore developed a single-item measure, the Perceived Adjustment to Chronic Illness Scale (PACIS), as an indicator of coping, complementary to other scales related to quality of life. We sought to validate this instrument in a subgroup of 121 Swiss patients participating in the International Breast Cancer Study Group (IBCSG) adjuvant trials. At months 3 and 6 of adjuvant treatment PACIS showed a distinct pattern of highly significant rank correlations with several disease- and treatment-related problem areas from the Herschbach coping inventory (FBBK); 42% of the variance of PACIS at month 3 was explained by the FBBK (P = .0001). The portion of explained variance was considerably higher for the Italian- (70%) than for the German-speaking (30%) subgroups. Patients who rated more effort to cope with their disease on PACIS indicated more frequent use of 3 of 15 coping strategies in relation to psychological distress. These were "crying and becoming desperate", "taking tranquillizers and alcohol" and "other people are far worse off". These three coping strategies may define a high-risk group for poor psychosocial outcome. Patients whose PACIS scores showed that it required less effort to cope tended to use the strategy "seeing a positive side of the problem". We conclude that PACIS can be used as a global indicator of the coping process in large multicultural clinical trials of adjuvant therapy for breast cancer.

The assumption is tested that women scoring high on dimensions of coping pattern termed "need for control," which underlies several of the components of Type A behavior, are at increased risk of ischemic cerebrovascular disease. Consecutively admitted patients to medical wards, nineteen with ischemic cerebrovascular disease, were compared with nineteen patients with non-arteriovascular disease and nineteen healthy females doing volunteer hospital work. "Need for control" was assessed by a psychometric test based on forty-five dichotomous items defining six unidimensional scales. The Bortner Type A behavior was filled out by the subjects and by their next of kin for an impression of the subject. In ANOVA the dimensions "work commitment, hard driving" (F = 6.87, p less than .002), "perfectionism, need for making plans" (F = 6.26, p less than .003), and "inability to withdraw from work obligations" (F = 3.89, p less than .02) differentiated the three groups in the expected direction. Duncan multiple range test resulted in very similar, significant findings, as did Bortner measures, filled out by a next of kin (F = 4.63, p less than .01). In all analyses, effects of age, current smoking, and coronary artery disease (CAD) were controlled. Our results suggest that high "need for control" defines a psychological risk in women suffering from ischemic stroke. Prospective studies should be undertaken. If they confirm our results, interventions aimed at modifying the "need for control" should be planned.