Purpose The aim of this study was to identify symptoms of severe intensity or very low scores for quality of life (QoL) domains in newly diagnosed outpatients with advanced cancer. Methods This multicenter cohort study from a state-wide palliative care network included adult outpatients with advanced cancer diagnosed within the preceding 8 weeks from four comprehensive cancer centers (DRKS00006162, registered on 19 May 2014). We used the Palliative Outcome Scale (POS), Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment of Cancer QoL Questionnaire-C30. For each questionnaire, cut-off scores defined symptoms and QoL domains that were considered "severe" or "very low." Results Of 3155 patients screened, 481/592 (81.3%) were analyzed (mean age 62.4; women n = 245, 50.9%). We identified 324/481 (67.4%) patients experiencing at least one severe symptom or a very low QoL domain (median 2; range 0 to 16). Role functioning (n = 180, 37.4%), fatigue (n = 162, 33.7%), and social functioning (n = 126, 26.2%) were most commonly affected. QoL was very low in 89 patients (18.5%). Women experienced more anxiety symptoms, fatigue, and had lower POS scores. Patients often mentioned physical symptoms and fears of adverse events resulting from disease-modifying therapies (e.g., chemotherapy) as most relevant problems. Conclusions Already within the first 8 weeks after diagnosis, the majority of patients reported at least one severe symptom or a very low QoL domain. Gender differences were evident. The findings illustrate the value of early routine assessment of patient burden and the development of multi-professional and interdisciplinary palliative care.

Neben patientenberichteten Outcomeparametern werden international auch aus klinischen Daten Qualitätsindikatoren (QI) zur Beurteilung der Versorgungsqualität von Tumorpatienten am Lebensende erhoben.

A consistent pain management together with treatment of dyspnoea belongs to the main issues in symptom control in particular in palliative thoracic oncology. Together with the medicamentous therapy the psychologic and social circumstances of the affected patients have to be considered as factors influencing the experience of pain. The therapeutic fundament according to the WHO guideline for cancer pain is the opiate based medicamentous adjustment combined with non-opioids. In principle, this should be performed preferably orally, as simply as possible, according to a fix drug schedule and individually adjusted to the needed dosage. Breakthrough pain has to be treated with rapidly efficacious, non-retarded analgetics. The typical adverse reaction profile for opiates like constipation and initial nausea should be considered prophylactically by applying concurrent medication with adjuvants. Co-analgesic drugs like anticonvulsiva or corticosteroids could support the analgetic effect and are used preferably in case of neuropathic pain. Primary aim in analgesic therapy is to achieve the best possible pain reduction and hence to safeguard quality of life.

Communication and the care of patients with advanced cancer are a dynamic, interactive and challenging process, often characterised in every day practice by discontinuity and lack of coordination. The objective of this study was to explore the patients' and family-caregivers' needs and preferences regarding communication, quality of life and care over the trajectory of disease. The second aim was to assess health professionals' views on a longitudinally structured, forward-thinking communication approach based on defined milestones. A qualitative approach was chosen incorporating semi-structured interviews with nine patients with metastatic lung cancer and nine relatives, and focus groups with 15 healthcare providers from different professions involved in the care of these patients. Patients and relatives described a situation of shock and coping deficits with moments of insufficient communication and lack of continuity in care. Healthcare providers reported the strong need for improvement in communication within the team and between patients and professionals and welcomed the implementation of a longitudinal communication approach. Requirements for the implementation of a longitudinal communication approach include specific communication training with focus on the process that patients and relatives are involved in. Team-building measures and the necessary flexibility to respect individuality in life should be incorporated.

Pathophysiologisch wird bei der Schmerzgenerierung zwischen nozizeptiven und neuropathischen Schmerzen unterschieden. Erstere unterliegen der direkten Erregung spezifischer Schmerzrezeptoren, letztere der Reizung peripherer Nerven oder Nervenwurzeln. Auch klinisch finden sich differente Schmerzqualitäten in Abhängigkeit von der jeweiligen Reizung. Während nozizeptive Schmerzen von den betroffenen Patienten in der Regel gut lokalisiert werden können, sind neuropathische Algesien eher ausstrahlend und werden vielfach als Missempfindungen mit brennendem Charakter beschrieben. Diese Differenzierung zwischen nozizeptivem und neuropathischem Schmerz hat insbesondere Bedeutung für die Auswahl und Kombination der passenden Analgetika.

Die konsequente Schmerztherapie ist ein wichtiger Pfeiler der Symptomkontrolle in der palliativmedizinischen Thoraxonkologie. Neben der medikamentösen Therapie sind die psychischen und sozialen Umstände der betroffenen Patienten als Faktoren zu berücksichtigen, die die Schmerzerfahrung mitbeeinflussen. Primäre Ziele sind das Erreichen einer größtmöglichen Schmerzarmut und damit die Sicherstellung einer ausreichenden Lebensqualität.

Neben patientenberichteten Outcomeparametern werden international auch aus klinischen Daten Qualitätsindikatoren (QI) zur Beurteilung der Versorgungsqualität von Tumorpatienten am Lebensende erhoben.

Background. In addition to outcome parameters reported by patients, quality indicators ( QI) derived from clinical data are also used internationally to assess the quality of end of life treatment for cancer patients.Objective. To determine the relevance of clinical QI for lung cancer patients and the feasibility of collecting these data in the clinical context and from cancer registries.Methods. A literature review and a survey of four German centers were carried out.Results. The large variance observed in patients with tumor-specific therapy in the last 14 days of life can be explained by the variation in the type of survey ( e.g. prospective vs. retrospective, survey within the framework of studies or based on registry or insurance data) as well as different definitions of the basic population, e.g. different tumor entities, exclusion of patients younger than 65 years when using the SEER databank and exclusion of patients who died shortly after the diagnosis. Data on tumor therapy in the last 14 days of life could be obtained with little effort both clinically and using regional cancer registries; however, compilation of data from patients in a hospice or specialized palliative care contact as well as finding advance directives ( e.g. inspection of patient charts) was much more complicated.Conclusion. The documentation of tumor-specific therapy in the last 14 days of life allows a reflection on the oncological care for terminally ill patients. If the same basic population data are used for the numerator and denominator, comparative analyses between countries and medical centers are possible.

Die Therapieziele beim metastasieten Lungenkarzinom sind i. d. R. palliativ, sodass die Symptomkontrolle und die Verbesserung der Lebensqualität neben der Lebenszeitverlängerung an vorderster Stelle stehen. Die hier vorgestellte randomisierte Studie von Temel et al. zeigte, dass eine frühzeitige palliative Intervention Symptome verringern, die Lebensqualität steigern und das Überleben verlängern kann.

Die Therapieziele beim metastasieten Lungenkarzinom sind i. d. R. palliativ, sodass die Symptomkontrolle und die Verbesserung der Lebensqualität neben der Lebenszeitverlängerung an vorderster Stelle stehen. Die hier vorgestellte randomisierte Studie von Temel et al. zeigte, dass eine frühzeitige palliative Intervention Symptome verringern, die Lebensqualität steigern und das Überleben verlängern kann.1

The prognostic role of estrogen receptors in lung cancer is not validated. Results from patients with early stage non-small lung cancer patients indicate a prognostic role of estrogen receptor 1 (ESR1) mRNA expression in these patients. Automated RNA extraction from paraffin and RT-quantitative PCR was used for evaluation of tumoral ESR1 and progesterone receptor (PGR) mRNA expression. The test cohort consisted of 31 patients with advanced or metastatic non-small cell lung cancer (NSCLC) patients, treated in a first-line registry trial. For validation, 53 patients from a randomized multicentre first-line study with eligible tumor samples were evaluated. There was no significant correlation of ESR1 expression with clinical characteristics. ESR1 high expression was of significant positive prognostic value in the training set with a median overall survival (OS) of 15.9 versus 6.2 months for high versus low ESR1 expression patients (p = 0.0498, HR 0.39). This could be confirmed in the validation cohort with a median OS of 10.9 versus 5.0 months in ESR1 high versus low patients, respectively (p = 0.0321, HR 0.51). In the multivariate analysis adjusted for histological subtype, gender, age and performance status, ESR1 expression remained an independent prognostic parameter for survival in both cohorts. In contrast to ESR1, PGR expression was not able to separate prognostic groups or to predict outcome significantly (for OS; p = 0.94). Our study shows that ESR1 mRNA as assessed by qPCR represents a reliable method for detecting ESR1 expression in NSCLC and that ESR1 expression is an independent prognostic factor in metastatic NSCLC.

Background. Many patients with metastatic lung cancer suffer from physical and psychological symptoms as well as of social and spiritual concerns. The goals of therapy are usually palliative. Factors like symptom control and quality of life are important in addition to prolonged survival in these circumstances. The randomised trial by Temel et al. presented here shows that early palliative care can reduce symptoms, improve quality of life and prolong survival. Objectives. The effect of early palliative care on quality of life and end-of-life care among ambulatory patients with newly diagnosed metastatic lung cancer was evaluated. Materials and methods. Patients with newly diagnosed metastatic lung cancer were randomised to treatment with standard therapy or standard therapy plus early palliative care. Quality of life and mood were assessed at baseline and at 12 weeks with the Functional Assessment of Cancer Therapy-Lung (FACTL) scale and the Hospital Anxiety and Depression Scale (HADS). The primary outcome was the change in quality of life at 12 weeks. The data of end-of-life care were collected from electronic medical records. Results. The palliative care group had significantly better quality of life and less depression. The end-of-life care was less aggressive and hospice care was integrated earlier and more often. The survival time was significantly prolonged. Conclusion. These data support the approach to integrate palliative care by a multiprofessional team early in the therapeutic concept for patients with newly diagnosed metastatic lung cancer.

IntroductionSagopilone is the first fully synthetic epothilone in clinical development and has proven preclinical activity in tumor models. This multicenter, randomized, open-label, phase II study examined the efficacy and safety of three regimens with two doses and two infusion durations of second-line sagopilone in pretreated patients with stage IIIB or IV non-small-cell lung cancer.MethodsEligibility criteria included: at least one measurable lesion by modified response evaluation criteria in solid tumors; World Health Organization performance status of 0 or 1; and failure of previous platinum-based chemotherapy. Patients were randomized to receive: 16mg/m2 sagopilone over 3h (treatment arm A); 22mg/m2 sagopilone over 0.5h (treatment arm B); or 22mg/m2 sagopilone over 3h (treatment arm C). Treatment duration was two to six courses every 3 weeks; more than six treatment courses were permitted if there was sustained clinical benefit. The primary efficacy endpoint was best overall response after six courses; at least five confirmed responders per arm indicated a successful outcome.ResultsIn total, 128 patients (44, arm A; 41, arm B; 43, arm C) were randomized; 127 received at least one infusion of sagopilone. Baseline demographic data were similar across all arms. Eight patients across all arms had a confirmed partial response; the primary endpoint was not achieved. The most frequently reported adverse event (AE) was peripheral sensory neuropathy (75%). Most hematologic AEs were grade 1 or 2.ConclusionAs fewer than five patients per arm responded after six treatment courses, the primary endpoint was not met. Sagopilone was only moderately tolerated. Most AEs, including peripheral neuropathy, were grade 1 or 2; hematologic toxicities were rare.