Sarkome umfassen eine seltene und histologisch heterogene Gruppe solider maligner Tumoren. Patienten mit Sarkom sind eine bisher vergleichsweise wenig untersuchte Patientengruppe.

鳞状细胞癌(SCC)是一种特定形式的皮肤癌,也是欧洲最常见的癌症之一。因此,SCC对患者本身以及在社会代价方面都造成了极大的负担。SCC的一个主要原因是暴露在自然阳光下,因此可以通过避免过度曝晒来预防SCC。外出时,人们可以利用衣物(例如长袖、帽子)和防晒霜来保护皮肤。到目前为止,SCC和其他皮肤癌的预防计划主要是尝试减少在休闲时间中的过度曝晒。然而,有许多人是在室外工作的,例如农民、建筑工人和屋顶工。职业(与工作相关)和休闲时间的阳光曝晒在导致SCC中所起的作用仍不明确。由德国的医生和科学家组成的团队调查了职业和休闲时间的阳光曝晒与SCC风险之间的关联。他们将超过600名SCC患者与相同数量的健康人员进行了比较,考虑到他们在过去的阳光暴晒因素。训练有素的医生们对所有研究参与者都进行了医学检查。参与者平时在职业和休闲时间中曝晒阳光的时间通过访谈进行评估。这些访谈在研究开始之间就进行了测试,以确保准确的结果。该项研究发现,在工作中过度曝晒的人员患SCC的风险是正常人的两倍。人们在工作中曝晒越多,SCC发生的概率就越高。这项结果非常重要,它指出,要预防SCC等皮肤癌,不仅在休闲时间中需要防晒,在工作中也同样需要。

BACKGROUND:Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukemia (AML) are hematological stem cell diseases mainly of the elderly. Studies indicate a close relationship between bone metabolism and hematopoietic stem cells within the osteo-hematopoietic niche. However, it remains unclear how the disturbed interaction within the osteo-hematopoietic niche affects bone homeostasis in MDS and AML patients.METHODS:We utilized data of a large German statutory health insurance of approximately 2 million persons living in the German federal state of Saxony. Applying case definitions based on diagnosis, procedures and prescriptions we identified prevalent and incident cases with MDS, AML and osteoporosis (OSP) in persons aged ≥60 years. We applied time-to-event analyses to determine the relationship of MDS and AML with OSP with a specific focus on temporality.RESULTS:Among all individuals aged ≥60 years (n = 891,095), 2.62% (n = 23,326), 0.14% (n = 1219) and 0.10% (n = 893) were identified with incident OSP, MDS and AML, respectively. The risk of incident OSP was significantly increased in patients with prevalent MDS (sex and age-adjusted model: HR = 1.87, 95%CI: 1.51-2.23). Conversely, patients with prevalent OSP had an increased risk to be diagnosed with incident MDS in the adjusted model (HR = 1.42, 1.19-1.65). For AML no significant associations were observed (adjusted models: inc. OSP with pre. AML; HR = 1.06, 0.65-1.47; inc. AML with pre. OSP; HR = 0.82, 0.41-1.23).DISCUSSION:Our results could indicate a clinically relevant relationship between MDS and OSP in elderly patients, most likely resulting from a disturbed microenvironment within the osteo-hematopoietic niche. An alternative, non-causal explanation that MDS is caused by the medication prescribed for OSP can be partially ruled out, as the association between the two diseases remains if incident OSP cases are considered in patients with pre-existing MDS. These results need to be confirmed within other prospective studies and may allow then for comprehensive strategies for the prevention, early detection and clinical care of patients with MDS and OSP.

Objective: The aim of this study was to investigate the role of occupational and nonoccupational ultraviolet (UV)-exposure concerning the development of basal cell carcinoma (BCC). Methods: We undertook a population-based multicenter case–control study. Patients with first incident BCC (n = 836) were propensity score matched by age and sex to controls without skin cancer (n = 836). Sociodemographic characteristics, clinical characteristics, and lifetime UV-exposure were assessed by trained investigators. The differential estimation of occupational and nonoccupational UV-exposure dosages was based on validated instruments and established reference values. Associations were assessed using multivariable-adjusted conditional logistic regression models. Results: Individuals with high levels of occupational UV-exposure were at significantly increased BCC-risk compared with individuals with low [odds ratio (OR) 1.84; 95% confidence interval (95% CI) 1.19 to 2.83 and moderate (OR 1.97; 95% CI 1.20 to 3.22) occupational UV-exposure. Nonoccupational UV-exposure was not independently associated with BCC. Conclusion: Skin cancer prevention strategies should be expanded to the occupational setting.

Squamous cell carcinoma (SCC) is a specific type of skin cancer. It is one of the most common cancers in Europe. SCC therefore causes a significant burden, both for the people affected and also in terms of costs to society. One main cause of SCC is exposure to natural sunlight. SCC can be prevented by avoiding sun exposure. When people go outside, they can protect themselves through clothes (e.g. long sleeves, hat) and using sunscreens. Until now, prevention programs for SCC and other skin cancers have mainly tried to reduce sun exposure during leisure time. However, there are many people working outdoors, e.g. farmers, construction workers and roofers. The role of occupational (work‐related) and leisure‐time sun exposure in causing SCC is still unclear. Our team of physicians and scientists from Germany investigated the association between occupational and leisure‐time sun exposure and the risk of SCC. More than 600 people with SCC were compared to the same number of healthy people without SCC, taking into account their sun exposure in the past. All study participants were medically examined by trained physicians. Lifetime sun exposure in occupation and leisure time was assessed by interviews. The interviews were tested before starting the study to ensure correct results. The study found that people with high levels of sun exposure at work have a 2‐fold risk of SCC. The more sun exposure people had at work, the more likely was the development of SCC. This result is important, as it indicates that sun protection is not only necessary in leisure‐time, but also at work to prevent skin cancer such as SCC.

Background: Colon cancer requires interdisciplinary care with quality of initial surgical treatment being a major prognostic factor. Implementation of quality standards based on structural and procedural indicators in routine care via certification (Germany) or accreditation (USA) is an established quality assurance method. However, evidence on effects is scarce. We undertook a population-based cohort study to investigate the effectiveness of colon cancer care in certified vs non-certified hospitals. Materials and methods: We utilized data of a large statutory health insurance including in - and outpatient data from 2005 to 2015 of >2 million individuals from Saxony, Germany. Case definitions were based on diagnosis, medical procedures and prescriptions. Patients treated in certified hospitals (CH) were compared to patients treated in non-certified hospitals (NCH) using logistic and Cox regression models adjusting for relevant confounders concerning overall survival (OS), disease-specific survival (DSS), 30-day mortality, recurrence, complications and second resections within 6 months after first resection (SR). Results: Overall, 6186 patients with incident colon cancer undergoing surgery were identified (mean age 74.1 +/- 11.0 years, 51.1% male) with 2120 (34.3%) patients treated in a CH. Confounder-adjusted regression models indicated positive effects in CH on OS (HR = 0.90, 95%CI: 0.83-0.97), DSS (HR = 0.71, 95%CI: 0.57-0.88), 30-day mortality (OR = 0.69, 95%CI: 0.55-0.87) and SR (OR = 0.51, 95%CI: 0.30-0.87). These results remained stable after adjustment for hospital volume. 30-day mortality in 2014 was 41% lower in CH (7.4%) compared to NCH (12.6%). Conclusions: This study indicates that the implementation and assurance of evidence-based quality standards has substantial positive effects on various patient-relevant outcomes in colon cancer care. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Objective:The aim of this study was to investigate the role of occupational and nonoccupational ultraviolet (UV)-exposure concerning the development of basal cell carcinoma (BCC).Methods:We undertook a population-based multicenter case-control study. Patients with first incident BCC (n=836) were propensity score matched by age and sex to controls without skin cancer (n=836). Sociodemographic characteristics, clinical characteristics, and lifetime UV-exposure were assessed by trained investigators. The differential estimation of occupational and nonoccupational UV-exposure dosages was based on validated instruments and established reference values. Associations were assessed using multivariable-adjusted conditional logistic regression models.Results:Individuals with high levels of occupational UV-exposure were at significantly increased BCC-risk compared with individuals with low [odds ratio (OR) 1.84; 95% confidence interval (95% CI) 1.19 to 2.83 and moderate (OR 1.97; 95% CI 1.20 to 3.22) occupational UV-exposure. Nonoccupational UV-exposure was not independently associated with BCC.Conclusion:Skin cancer prevention strategies should be expanded to the occupational setting.

There are a few epidemiological studies that (1) link increased ambient air pollution (AP) with an increase in lung cancer incidence rates and (2) investigate whether residing in green spaces could be protective against cancer. However, it is completely unclear whether other forms of cancer are also affected by AP and if residential green spaces could lower cancer incidence rates in general. Therefore, the objective was to estimate whether AP and green space are associated with several cancer types.

Background: Inclusion of patient-reported outcomes (PROs) in routine cancer care is of key importance for individualized treatment, shared decision making and patient satisfaction.& para;& para;Objective: To describe the implementation under routine conditions of an electronic self-administered PRO assessment and comparison of PROs before and after inpatient treatment in oncologic care.& para;& para;Methods: In a tablet-based survey PROs on symptom burden, global health status/quality of life (QoL) and health utility were collected twice (at hospital admission and discharge) in an inpatient ontological setting over a 17-month period using the EORTC QLQ-C30 and EQ-5D questionnaires. Data were linked to the hospital information system (HIS). Patient acceptability, recruitment rates, symptom burden, and clinically meaningful changes in PROs over time were analyzed.& para;& para;Results: From a total of 384 hospitalized patients invited to participate at admission 371 (96.6 %) participated. At discharge, 195 patients were approached for a follow-up assessment, and 192 patients (98.5 %) participated. Despite strong acceptance among patients, recruitment rates were decreasing over time. During the hospital stay clinically meaningful improvements were observed for health utility (33.3 %, n = 64) and global health status/QoL (43.2 %, n = 83). Patients reported a variety of symptoms at admission and discharge.& para;& para;Conclusions: Implementation of PRO assessment in routine care and data integration into the HIS provides valuable information for the entire medical staff as symptom burden is present during the entire hospital stay.& para;& para; Implications for Practice: Long-term maintenance of PRO assessment in a clinical setting as a prerequisite of value-based healthcare requires continuous involvement of the nursing team, which can only be achieved by allocating resources to this task.

Eine erfolgreiche chirurgische Behandlung ist ein entscheidender prognostischer Faktor in der Behandlung von Patienten mit Kolonkarzinom. Dabei spielt die Versorgungsqualität der behandelnden Klinik eine entscheidende Rolle. Zertifizierungen gelten als Qualitätssiegel für die Umsetzung leitliniengerechter Behandlungsstrategien in der Versorgung von Patienten mit Tumorerkrankungen. Die Studie untersucht die Wirksamkeit der Versorgung von Patienten mit chirurgischer Behandlung eines Kolonkarzinoms in Abhängigkeit des Qualitätsbewusstseins der behandelnden Klinik im Sinne einer Zertifizierung.

HINTERGRUND:Versorgungsregister dienen der Erfassung des Einsatzes und der Wirksamkeit von Therapien unter realen Versorgungsbedingungen und sind als Basis einer evidenzbasierten Gesundheitsversorgung unverzichtbar. METHODIK:Das deutsche Neurodermitis-Register TREATgermany wurde als weltweit erstes Register für Patienten mit schwerer Neurodermitis 2011 initiiert. Erwachsene mit schwerer Neurodermitis (aktuelle/frühere antientzündliche Systemtherapie und/oder objektiver SCORAD ≥ 40) werden über einen Zeitraum von 24 Monaten prospektiv beobachtet. Anhand validierter Erhebungsinstrumente werden die klinische Erkrankungsschwere (EASI, SCORAD), Lebensqualität (DLQI), Symptome, globale Erkrankungsschwere sowie die Patientenzufriedenheit erfasst und die durchgeführten Therapien dokumentiert. Die vorliegende Analyse beschreibt die Charakteristika, Therapiewahl und Wirksamkeit der eingesetzten antiinflammatorischen Systemtherapien der bis Oktober 2014 eingeschlossenen Patienten. ERGEBNISSE:An fünf Zentren wurden insgesamt 78 Patienten (Durchschnittsalter 39 Jahre, 61 % männlich) eingeschlossen. Bei den Patienten besteht eine hohe Inanspruchnahme ambulanter und stationärer Leistungen. Ciclosporin war das am häufigsten eingesetzte Systemtherapeutikum und zeigte die höchste klinische Effektivität (EASI-50-Ansprechrate 51 %; EASI-75-Ansprechrate 34 % nach zwölfwöchiger Therapie). Azathioprin, Methotrexat (MTX), Prednisolon oral, Mycophenolat, Alitretinoin und Leflunomid wurden ebenfalls bei einzelnen Patienten eingesetzt. SCHLUSSFOLGERUNGEN:Die vorliegende Registerauswertung gibt wichtige Hinweise zur derzeitigen Versorgung von Erwachsenen mit schwerer Neurodermitis in Deutschland, dokumentiert die hohe Erkrankungslast, den Nutzen vorhandener Therapien und den Bedarf an weiteren, effektiven und in der Langzeitanwendung sicheren Therapieoptionen.

Hohe Luftschadstoffkonzentrationen können Krebs verursachen. Allerdings gibt es nur wenige Studien, die untersuchen ob eine hohe Vegetationsintensität vor Krebs schützen kann. Diese Studie analysiert die Assoziationen von Luftschadstoffexpositionen und Vegetationsintensität in der Wohnumgebung bei mehreren inzidenten Krebsformen.

Purpose "Shared decision making" has been proposed as a prerequisite of patient-centered care. However, little is known on factors, which may influence cancer patients' decision control preferences (DCP) in routine care. This study investigated possible determinants of the patients' DCP with respect to patient characteristics and patient-reported outcomes (PROs). Methods Consecutive patients presenting at a comprehensive cancer center between May 2014 and October 2014 were offered a self-administered electronic questionnaire including standardized PRO measures and patients' DCP. Results were linked with patient characteristics from the hospital information system and analyzed using cross-sectional methods. Results Out of 126 patients participating, 102 (81%; 65% male; mean age 62 years) completed the DCP-item. Overall, 49% (n = 50) preferred shared treatment decision responsibility, 29% (n = 30) preferred to leave the control to his/her physician, whereas 22% (n = 22) preferred to be in control of his/her treatment decision. Higher age (p = 0.035) and elevated distress levels (p = 0.038) were significantly associated with an increased willingness to leave the decision control to the physician. Further sociodemographic and PRO measures were not associated with patients' DCP. Conclusion Our findings demonstrate that DCP assessment in routine cancer care is possible and provides important information to the treating oncologist. Information on DCP combined with PRO may contribute to more individualized decision making in cancer care.

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/bjd.15906 This article is protected by copyright. All rights reserved. DR JOCHEN SCHMITT (Orcid ID : 0000-0003-0264-0960)

We would like to thank Ruan et al. (2016) for highlighting the increasingly important political issue related to the discussion on effectiveness and efficacy of multimodal pain therapy (MPT) on the basis of the systematic review on outcomes in MPT by Deckert et al. (2016). We observe with concerns the current development of MPT programmes in the United States, as they were the cradle of this innovative therapeutic approach. The concept of functional restoration – one of several realizations of a biopsychosocial programme on treating chronic pain – has significantly influenced the concept of interdisciplinary multimodal pain therapy in Germany (Kaiser et al., 2015a). Now, after several decades of experience in this field we are facing political struggles. We are also challenged by criteria concerning a superficial understanding of cost effectiveness while losing a comprehensive understanding of effectiveness, for example, considering patients who are satisfied with their results or subsequent costs resulting from an insufficient therapy intervention. Comprehensive therapy programmes such as MPT are certainly cost intensive, but comprehension is necessary to overcome the burden of complex conditions such as chronic pain. Not only for Germany but also for other countries, health care restrictions as reported by Ruan et al. and some others are major obstacles. Other difficult issues are the lack of a consistent and consented definition of MPT (synonymously applied for multidisciplinary, interdisciplinary, comprehensive therapy approaches) clearly indicating aims, conceptual framework and obligatory professions involved as well as the lack of a core outcome set to identify reliable therapy effects and to distinguish them from random and concomitant effects (Kaiser et al., 2015b). Furthermore, we need to develop quality indicators for an effective MPT including the perspective of the patients themselves. Without having solved these problems, a scientific evaluation of MPT will remain difficult or be even impossible. Fortunately, the German health care system covers the costs for MPT in Germany so far, but an increasing number of facilities providing therapies accounting for MPT without realizing the requirements as defined by the German task force on MPT. This may lead to a rising number of patients not being satisfied, increasing costs and therefore decreasing acceptance of MPT among the various stakeholders in the health insurance system. This development might endanger the existence of MPT in Germany as well. Under the auspice of the German IASP chapter, counteracts to this trend are the development of a nationwide accepted definition of MPT, the definition of structure and process quality indicators for pain management facilities (Sabatowski et al., 2011), the description of process quality indicators in MPT as well as the implementation of a structured assessment process before starting MPT. One of the next steps will include the provision of verifiable indicators of MPT programmes, who are fulfilling the high standards as defined by the task force, to politicians and payers. The discussion on MPT and its position in the treatment of patients with chronic pain should not only be held exclusively within the medical society. An open-minded discussion including all stakeholders being involved, such as politicians, health care providers, payers and patient representatives, is required. Furthermore, an international discussion has to be initiated, as MPT providers all over the world are seemingly facing more or less the same problems. We would like to thank Ruan et al. for starting this important discussion in the European Journal of Pain.

Soft tissue sarcoma comprises a heterogeneous group of solid malignant tumours. Comorbidities are important prognostic factors for survival and adversely impact quality of life. We examined the complex relationship between soft tissue sarcoma and comorbidities over time in a large population-based sample. The study uses routine data from the German statutory healthcare system (n = 2,615,865). Case identification of soft tissue sarcoma and comorbid diseases was based on ICD-10 codes and diagnostic modifiers. Uni- and multivariate regression models were used to obtain risk estimates for chronic somatic and mental comorbidities in soft tissue sarcoma patients compared to a cancer-free control group. At diagnosis, patients with soft tissue sarcoma were significantly more likely to be affected with prevalent bronchial asthma, ≥1 cardiovascular risk factor (hypertension, angina pectoris, heart failure, peripheral arterial disease and thrombosis), back pain, depression, anxiety disorder and adjustment disorder than cancer-free controls. During the course of disease, sarcoma patients were at a significantly higher risk to develop incident depression, anxiety disorder and adjustment disorder. Comorbidities need to be considered in clinical decision making regarding the treatment of soft tissue sarcoma patients. Psycho-oncological treatment should be incorporated into medical care of patients with sarcoma.