Die ambulante Palliativversorgung ist mit hohen Erwartungen verbunden. Im Palliativnetz Bochum e.V. wurde versucht, eine Methode zur Überprüfung der Versorgungsqualität zu erarbeiten, welche sich als langfristiges Instrument zur Qualitätssicherung- und Verbesserung eignet.

Einleitung: Das Palliativnetz Bochum wurde 2005 gegründet. Mit zunehmender Patientenzahl und multidisziplinärer Versorgung der Palliativpatienten entstand die Notwendigkeit eines gemeinsamen Kommunikationsmittels am Bett des Patienten.

Fragestellung: Die Bedeutung einer umfassenden Versorgung von Palliativpatienten wurde durch die seit 2010 bestehende gesetzliche Regelung in Deutschland hervorgehoben. Bei der Palliativbetreuung stellt die Schnittstelle zwischen stationärer und ambulanter Versorgung einen möglichen Reibungspunkt dar, der für Patienten, Angehörige und Betreuungsteams mit erheblichen Belastungen einhergehen kann. In der vorliegenden Arbeit wurde deshalb untersucht, inwieweit Symptome und Maßnahmen im Verlauf der stationären und ambulanten Palliativversorgung, insbesondere beim Übergang von der Klinik in die häusliche Umgebung eingeschätzt und genutzt werden.

Since few studies focus on prognostic factors in unselected elderly acute myeloid leukemia (AML) patients, a retrospective analysis of 138 consecutive patients aged >55 years (median age: 67, range: 56–89) with AML diagnosed at a single center over an 8-year period was performed: 69% had de novo AML and 31% secondary (s) AML; 67% of the patients were karyotyped. Of the patients, 73 (53%) were treated with standard induction therapy protocols and 65 (47%) received palliative treatment only. Univariate and multivariate analyses of the effects of the following factors on overall survival (OS) were performed: sex, age ≥ vs <65 years, de novo vs sAML, serum (s) lactate dehydrogenase (LDH) ≥ vs <400 U/l, leukocytes ≥ vs <50,000/µl, induction therapy, and karyotype. Additionally, in patients receiving induction therapy, complete remission (CR) rates and survival from CR were analyzed. CR rate was 47% [95% confidence interval (35%, 59%)], 53% (39%, 66%) in de novo AML, and 21% (5%, 51%) in sAML. After a median follow-up of 4 years, 130 deaths were observed (94%). In a univariate analysis, significant factors for longer OS were induction therapy, age <65 years, sLDH <400 U/l, and de novo AML. In a multivariate analysis, significant factors for longer OS were sLDH <400 U/l and induction therapy. However, the difference between treatment outcome may also be due to selection criteria not captured, such as performance status, comorbid conditions, wish of the patient, etc. The effects of intensive and nonintensive treatment in this patient group need to be investigated in prospective, randomized trials in which these clinical parameters of high relevance for treatment decisions in older patients are also considered.

Background. A retrospective analysis was performed on 138 consecutive patients aged >55 years (median age 67, range 56–89) with AML diagnosed at a single center over an 8-year period (1/1991 to 12/1998). 69% had de-novo AML, 31% secondary (s)AML. 73 patients (53%) were treated with standard induction therapy protocols, followed by cytarabine- based consolidation, whereas 65 patients (47%) received palliative treatment only.Methods. Univariate analyses of overall survival (OS) were performed for sex, age ≥ vs. <65 years, de-novo ami vs. sAML, serum (s)LDH ≥ vs. <400 U/l, leukocytes ≥ vs. <50000/μl, induction therapy and karyotype. Cytogenetics (available in 67%) were normal in 41 pts, favorable (t[15;17]) in 1, adverse (3q abnormalities, 5q-, -5, -7, complex) in 23 and intermediate (other abnormalities) in 12 cases.Results. Overall CR rate in patients receiving induction therapy was 47% (53% in de-novo AML, 21% in sAML). After a median follow- up of 4 years, 130 deaths have been observed (94%). In a univariate analysis, significant factors for longer OS were induction therapy, age <65 years, sLDH <400U/1 and de-novo AML. In a multivariate analysis, significant factors for longer OS were sLDH <400 U/l and induction therapy (difference possibly explained also by selection criteria not captured, such as performance status).Conclusions. Selected AML patients aged 56 to 64 years and receiving standard-dose induction treatment had significantly longer OS than patients not receiving induction. This difference was not significant in the cohort aged ≥65 years. In a multivariate analysis, sLDH emerged as an independent prognostic factor for OS. The effects of intensive and non-intensive treatment in this patient group need to be investigated in prospective trials in which clinical parameters of high relevance for treatment decisions in elderly patients (performance status, comorbidity etc.) are controlled for.