Purpose:Autologous stem cell transplantation (ASCT) for the treatment of multiple myeloma and lymphoma patients has been reported to improve relapse-free (RFS) and overall survival (OS). Nonetheless, the impact on patient-reported outcomes, such as professional activity and health-related quality of life (HRQoL) remains unclear. Patients and methods:In a cross-sectional two-center study, we collected data of 122 patients receiving high-dose chemotherapy followed by ASCT for multiple myeloma (MM) or lymphoma between 2007 and 2023 at two German tertiary care centers through standardized questionnaires. Results:The median age of all patients at diagnosis was 56 years (range 24-67 years). 17.9% of patients received a second ASCT. 55.0% and 61.9% of patients achieved a complete remission after first and second ASCT, respectively. The median time to resumption of employment was 167 days and the overall rate of return to work (RTW) was 56.0%. Following ASCT, 29.0% of patients reduced their working hours and 95.4% had a recognized disability status.The median quality of life/health status QLQ-C30 score after ASCT was 66.7 out of 100. A QoL/health status of < 50 was significantly associated with a lower rate of resumption of professional activity (HR 0.44, 95% CI: 0.26-0.78, p = 0.02). 86.0% of all patients reported fatigue symptoms. The QLQ-MY20 score for fears of the future was significantly higher than for disease symptoms and therapy side effects (p < 0.0001), indicating that after ASCT, psychological symptoms affected patients more than somatic aspects. Conclusion:Our study suggests that long-term toxicities of ASCT significantly impact patients' HRQoL and impair their professional activity. Treatment should include an assessment of mental health and socioeconomic status and provide necessary support.

BACKGROUND/AIM:The Sarco-Detect study aim was to test the suitability of bioimpedance analysis (BIA) as a cost-efficient and practical alternative to computed tomography (CT) for diagnosing sarcopenia and to assess the agreement between CT and BIA. PATIENTS AND METHODS:In this study, the skeletal muscle cross-sectional area (SMA) was measured at the third lumbar vertebra (L3) on CT images, and the skeletal muscle index (SMI) was calculated. BIA skeletal muscle mass (SMM) and appendicular SMM (ASMM) were determined using the manufacturer's software (SMM-Seca, ASMM-Seca) and using the Sergi and Kyle equations. All calculated masses were converted to height-normalized index values and compared with the European Working Group on Sarcopenia in Older People cut-offs. RESULTS:A total of 70 patients were included, with mean (± standard deviation) age of 66±11 years, body mass index of 25±5 kg/m2, CT-SMA of 135.55±32.01 cm2, and CT-SMI of 44.28±8.14 cm2. BIA results were 13.85±3.85 kg according to ASMM-Seca, 23.45±5.64 kg using ASMM-Sergi, and 21.86±5.74 kg using ASMM-Kyle. The highest Pearson correlation was determined between SMI-Seca and CT-SMI (r=0.839, p<0.01), followed by ASMI-Sergi (r=0.831, p<0.01). Comparing absolute SMM values, SMM-Seca showed the highest correlation with CT-SMA (r=0.917, p<0.01) followed by ASMM-Kyle and ASMM-Sergi (r=0.905 and r=0.904, respectively; p<0.01). When diagnosing sarcopenia, SMI-Seca showed the highest sensitivity of 50% (specificity 73%) followed by ASMI-Kyle at 38% (specificity 81%) and ASMI-Sergi at 13% (specificity 91%). Compared to the reference method (CT-SMI), 17 patients were falsely identified as having sarcopenia via the calculation of SMI-Seca and four patients with sarcopenia were not detected. CONCLUSION:The results indicate limited congruence of BIA and CT in the diagnosis of sarcopenia.

ABSTRACT Purpose The main objective of the Sarco‐Detect study was to evaluate diagnostic tools—bioelectrical impedance analysis (BIA) and handgrip strength (HGS)—for determining sarcopenia compared with computed tomography (CT). The secondary aim was to evaluate the SARC‐F questionnaire as a screening tool and to investigate the impact of muscle loss on quality of life, fatigue, HGS, and the association between previous physical activity and muscle loss. Methods The study was conducted at the University Cancer Center Schleswig‐Holstein. To assess muscle mass status, BIA and HGS were measured in patients with cancer and compared with CT. Additionally, EORTC QLQ‐C30, FACIT‐Fatigue Scale, BSA, and SARC‐F questionnaires were administered. Results One hundred thirty one patients were recruited. Fourteen patients showed a CT‐SMI below the reference values by Van der Werf et al. (2018). Thirteen patients showed reduced HGS. CT‐SMI and HGS correlated significantly (r = 0.492, p = 0.001). The phase angle of the BIA correlated significantly with CT‐SMI (r = 0.441, p = 0.001) and HGS (r = 0.493, p = 0.001). Patients with reduced HGS presented significantly higher appetite loss compared with patients with preserved HGS. Patients with preserved HGS showed a higher quality of life than patients with reduced HGS. FACIT‐Fatigue scores differed significantly between patients with reduced HGS and those with preserved HGS (F(1, 104) = 3.991, p = 0.048; U = 321.000, Z = −2.088, p = 0.037). Activity index correlated moderately with fatigue symptoms and quality of life. The SARC‐F showed a sensitivity of 18.8% and specificity of 96.6% for HGS, and a sensitivity of 31.3% and specificity of 90.7% for CT‐SMI. Conclusions CT‐SMI and HGS correlated positively and significantly. The BIA phase angle correlated with CT‐SMI and HGS. Reduced HGS is associated with increased appetite loss, higher fatigue, and lower quality of life. SARC‐F questionnaire appears suitable for identifying patients without sarcopenia. Trial Registration German Clinical Trials Register: DRKS00035258

BACKGROUND:With increasing life expectancy, the number of elderly patients diagnosed with locally advanced head and neck squamous cell carcinoma (HNSCC) is rising. The effectiveness of definitive radiotherapy (RT) regimens in this population remains unclear. This study investigates RT regimen trends and their impact on overall survival (OS) and locoregional recurrence (LRR) in elderly HNSCC patients using a large German cancer registry dataset. METHODS:A retrospective analysis of 84,046 HNSCC cases from 2000 to 2022 was conducted. RT administration trends were assessed in patients aged ≤ 70 years and > 70 years. OS and LRR were analyzed in patients receiving definitive RT alone or combined with chemotherapy (RCTx) or cetuximab (RT-Cet), using Kaplan-Meier estimates and multivariate Cox regression models. RESULTS:The proportion of elderly patients receiving definitive RT regimens increased significantly over time. Platinum-based RCTx remained the most frequently used regimen but was less common in patients > 70 years than in younger patients (26 % vs. 57 %, P < 0.001). Five-year OS following platinum-based RCTx was comparable between age groups (HR 1.01, P = 0.83). In contrast, RT-Cet was associated with significantly worse OS and higher LRR compared to platinum-based RCTx, with a stronger negative impact in patients > 70 years (OS: HR 2.31, P < 0.001; LRR: HR 2.11, P = 0.003) than ≤ 70 years (OS: HR 1.55 P < 0.001; LRR: HR 1.43, P = 0.002). This age-related difference was not observed with RT alone. CONCLUSIONS:Platinum-based RCTx remains the most effective treatment for elderly HNSCC patients. RT-Cet is associated with poorer outcome particularly in patients > 70 years, underscoring the need for age-adapted, biology-informed treatment strategies.

BACKGROUND:Patients with advanced cancer frequently suffer from frailty associated with vulnerability and adverse outcomes. Our aim was to assess the prevalence of frailty and elucidate the utility of two commonly used frailty questionnaires in an advanced cancer population. METHODS:The Fried Frailty Phenotype (FFP) and Simple FRAIL Questionnaire (SFQ) were assessed in hospitalized patients with mostly advanced cancer. Patients were classified by both questionnaires as frail (3-5 points), pre-frail (1-2 points) and robust (0 points) and followed up for all-cause mortality. Utility was evaluated with correlation and survival analysis. RESULTS:From 11/2017 to 02/2020, 251 mostly advanced cancer patients (61 ± 13 years, 53% men, BMI 25.3 ± 4.8 kg/m2, 78% cancer stage ≥ 3) were prospectively enrolled. In cancer patients, according to the FFP and SFQ, 17%/13% were frail, 52%/41% prefrail and 31%/47% robust. The correlation between both scores was strong (rs = 0.65, p < 0.001). Both scores were predictors of mortality of cancer patients in univariable and multivariable Cox proportional hazards analyses (multivariable adjusted: per 1 point: FFP: HR 1.36, 95% CI, 1.15-1.61, p < 0.001; SFQ: HR 1.29, 95% CI, 1.09-1.52, p = 0.003-adjustment for age, cancer stage/type, anti-cancer therapy naïve, sex, BMI, CKD and anaemia). The time-dependent multivariable adjusted area under the receiver operating characteristic curve for 6-/24-month survival follow-up for the FFP was 0.78 (95% CI, 0.70-0.86)/0.92 (95% CI, 0.87-0.98) and for the SFQ was 0.79 (95% CI, 0.69-0.88)/0.90 (95% CI, 0.83-0.97). CONCLUSION:Frailty and pre-frailty as assessed by FFP and SFQ are commonly found in advanced stage cancer patients. Both questionnaires have a strong correlation and are associated with all-cause mortality in this population. Since the SFQ is easier and quicker to perform, it can be used remotely, and with untrained staff, it might facilitate earlier preventive measures and initiate further actions to mitigate its impact.

Prior research indicates that engaging in physical activity during chemotherapy can positively influence both physical and psychological parameters in individuals with hematological neoplasms. However, the most effective type, level, intensity, and frequency of exercise remains unclear. We enrolled 53 patients to a clinical trial assessing a partly supervised hybrid training program including both strength and endurance components, commencing at onset of induction therapy (T0) for hematological malignancies, including AML (n = 29), ALL (n = 5), and NHL (n = 19). Endpoints to evaluate efficacy included muscle strength in kg, cardiovascular fitness in steps, balance in scores, quality of life (QoL), and fatigue. Data were compared at three time points: the beginning of treatment (T0), during consolidation (T1), and 12 ± 2 weeks later (T2). Average adherence to protocol specified activities was 63.2

OBJECTIVE:This study aimed to assess the experiences and expectations regarding advance directives among patients with gynecological cancer, with an additional focus on patients with migration backgrounds. METHODS:An anonymous, self-administered questionnaire comprising 38 multiple-choice questions on advance directives was distributed online and in paper form from May 2019 to April 2021 across Germany. Participants included women diagnosed with various gynecological tumors. The survey was available in German, Turkish, Arabic, and Russian to capture culture-specific differences. RESULTS:Out of 718 participants, 355 (49.4%) reported having an advance directive. Patients with an advance directive were significantly older (64.5 years) compared to those without (56.0 years, p < .0001). Advanced tumor stage (Fédération Internationale de Gynécologie et d'Obstétrique III and IV) was not significantly associated with having an advance directive (OR 0.82, 95% CI 0.49 to 1.35, p = .43). Compared to women with ovarian/fallopian tube/peritoneal cancer, those with cervical cancer (OR 0.7, 95% CI 0.35 to 1.39, p = .31), endometrial cancer (OR 0.43, 95% CI 0.16 to 1.12, p = .09), and vulvar cancer (OR 0.58, 95% CI 0.16 to 2.04, p = .39) were less likely to have an advance directive. A total of 56.8% of patients believed their family doctor should initiate end-of-life care discussions. Among the 18.2% of women with migration backgrounds, there was a lower likelihood of having an advance directive (OR 0.61, 95% CI 0.35 to 1.03, p = .07) and a significantly higher desire for information and documentation about advance directives in their native language (p = .0001). A total of 330 (48.4%) patients reported that a conversation with their physician would be the most important way to receive information about end-of-life care and advanced directives. CONCLUSIONS:This study highlights a substantial need for enhanced information and proactive discussions about end-of-life care among patients with gynecological malignancies, particularly emphasizing the pivotal role of family doctors in these conversations. Notably, women with migration backgrounds are disproportionately disadvantaged in accessing and understanding advance directives, underscoring the urgent need for information and documents about advance directives in their native language. It is therefore recommended that the medical team routinely and proactively address these relevant topics in discussions with their patients and that clinical guidelines should also reflect this.

OBJECTIVE:Family caregivers play a critical yet often overlooked role in healthcare, facing the dual challenge of providing clinical care while managing their emotional well-being. Although several studies have investigated the supportive care needs and services for caregivers of advanced cancer patients integrated into specialized palliative care inpatient units, little is known about cancer caregiver integration and support structures in German outpatient cancer care. This qualitative study addresses this gap by exploring the experiences of family caregivers in Germany, using a dyadic approach to assess their needs, identify referral strategies, and evaluate oncologists' perspectives on improving caregiver integration and support. METHODS:Thematic analysis was conducted on semi-structured interviews with 14 advanced cancer patients, 15 family caregivers, and 3 oncologists. MAXQDA software facilitated the identification of key themes and codes. RESULTS:Three interconnected themes emerged: (1) The Impact of Illness on the Dyadic Relationship, (2) Communication with Physicians and Understanding of Healthcare Information, and (3) Challenges and Preferences in Navigating Healthcare Services and Psychosocial Support. SIGNIFICANCE OF RESULTS:The findings highlight the need for enhanced support in caregiving to improve cancer care quality, emphasizing that early palliative care integration is vital for addressing caregiver needs as a core component of comprehensive cancer care. Healthcare practices should adopt personalized, proactive support strategies from diagnosis, implement regular needs assessments, and leverage digital healthcare tools to enhance the efficacy and efficiency of caregiver support.

Background In addition to the effect of body weight, a patient’s sex can influence the pharmacokinetics (PK) of anticancer agents, and thereby their activity and safety. The magnitude and relevance of sex differences, however, are currently unclear. Methods We carried out a systematic review of published studies (clinical, n ≥ 10) on Food and Drug Administration (FDA)-approved (on 31 January 2022) anticancer drugs (excluding hormonal agents), aiming to identify significant PK differences between male and female patients. A difference of ≥20% on PK parameters (clearance or trough concentration) was considered significant. The methodological quality was assessed using the National Institutes of Health study quality assessment tool. This systematic review was conducted according to the PRISMA2020 guidelines and a previously published protocol, which was registered in the PROSPERO database (number 291008). Results Data on 99 anticancer agents (for a total of 1643 abstracts and European Medicines Agency/FDA documents) were screened. The final dataset included 112 articles and 8 European Medicines Agency/FDA documents. The median size of a study cohort was 445 patients (range: 12-6468 patients). Significant PK differences (>+20% in clearance or apparent clearance in women) were identified for 14 drugs, and potentially significant PK differences (due to conflicting reports) for another 8 drugs. None of the studies included sex-based summaries to assess whether the observed differences in PK may impact the efficacy or safety profile. Conclusions Significant sex differences in PK have been identified including commonly used drugs of different classes, such as 5-fluorouracil, doxorubicin, paclitaxel, regorafenib, atezolizumab, and temozolomide. The risk–benefit ratio for such anticancer drugs is likely to be improved by the development of sex-specific dosing strategies. Additional sex-based PK-pharmacodynamic analyses are recommended during dose optimisation and are to be conducted in line with the FDA Project Optimus guidance. They should be reported even if no association between the patients’ sex and the activity and/or toxicity of an anticancer drug has been identified.

Definition of the problemPatients' living conditions can become barriers to the implementation of a desired therapy-for example, cancer therapy-and jeopardize its success.MethodsThis paper examines whether challenging living conditions should be systematically considered in treatment decisions. For this purpose, the Capabilities Approach according to Martha Nussbaum is used. Subsequently, suggestions are formulated on the basis of Florencia Luna's concept of layers as to how social vulnerabilities can be better included into practice.ConclusionThere is an ethical obligation to include the knowledge of challenging living conditions in treatment decisions. If necessary, patients should be offered support in order to enable them to access the therapy they have chosen. Living conditions that can have an impeding effect on adherence can be understood as layers of social vulnerability.