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Heindl F, Fasching PA, Hein A, Hack CC, Heusinger K, Gaß P, Schulz-Wendtland R, Hartmann A, Erber R, Beckmann MW, Meyer J, Häberle L, Jud SM. Mammographische Dichte und Prognose bei Patientinnen mit primärem Mammakarzinom – Risikoverlust durch zunehmendes Alter. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- F Heindl
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - PA Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - A Hein
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - CC Hack
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - K Heusinger
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - P Gaß
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - R Schulz-Wendtland
- Institut für Diagnostische Radiologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - A Hartmann
- Institut für Pathologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - R Erber
- Institut für Pathologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - MW Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - J Meyer
- Biostatistische Einheit, Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - L Häberle
- Biostatistische Einheit, Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - SM Jud
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
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Gaß P, Häberle L, Hein A, Jud SM, Lux MP, Hack CC, Emons J, Heindl F, Nabieva N, Loehberg CR, Schulz-Wendtland R, Hartmann A, Beckmann MW, Fasching PA, Wunderle M. Einfluss der Familienanamnese eines Mamma- oder Ovarialkarzinoms auf die pathologische Komplettremission und die Prognose bei Patientinnen mit einem Mammakarzinom nach neoadjuvanter Chemotherapie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- P Gaß
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - L Häberle
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - A Hein
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - SM Jud
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - MP Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauen- und Kinderklinik St. Louise
- St. Josefs-Krankenhaus
| | - CC Hack
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - J Emons
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - F Heindl
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - N Nabieva
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - CR Loehberg
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - R Schulz-Wendtland
- Institut für Diagnostische Radiologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen-Nürnberg
| | - A Hartmann
- Institut für Pathologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen-Nürnberg
| | - MW Beckmann
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - PA Fasching
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - M Wunderle
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
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Wunderle M, Häberle L, Hein A, Jud SM, Lux MP, Hack CC, Emons J, Heindl F, Nabieva N, Löhberg CR, Schulz-Wendtland R, Hartmann A, Beckmann MW, Fasching PA, Gaß P. Einfluss der Familienanamnese eines Mamma- oder Ovarialkarzinoms auf die pathologische Komplettremission und die Prognose bei Patientinnen mit einem Mammakarzinom nach neoadjuvanter Chemotherapie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Wunderle
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - L Häberle
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
- Biostatische Einheit, Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - A Hein
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - S M Jud
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - M P Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauen- und Kinderklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten
| | - C C Hack
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - J Emons
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - F Heindl
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - N Nabieva
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - C R Löhberg
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - R Schulz-Wendtland
- Institut für Diagnostische Radiologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - A Hartmann
- Institut für Pathologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - P A Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - P Gaß
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
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Hack CC, Häberle L, Brucker SY, Janni W, Volz B, Loehberg CR, Hartkopf AD, Walter CB, Baake G, Fridman A, Malter W, Wuerstlein R, Harbeck N, Hoffmann O, Kuemmel S, Martin B, Thomssen C, Graf H, Wolf C, Lux MP, Bayer CM, Rauh C, Almstedt K, Gass P, Heindl F, Brodkorb T, Willer L, Lindner C, Kolberg HC, Krabisch P, Weigel M, Steinfeld-Birg D, Kohls A, Brucker C, Schulz V, Fischer G, Pelzer V, Rack B, Beckmann MW, Fehm T, Rody A, Maass N, Hein A, Fasching PA, Nabieva N. Complementary and alternative medicine and musculoskeletal pain in the first year of adjuvant aromatase inhibitor treatment in early breast cancer patients. Breast 2020; 50:11-18. [PMID: 31958661 PMCID: PMC7377331 DOI: 10.1016/j.breast.2019.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 12/25/2022] Open
Abstract
Background Patients with breast cancer (BC) show strong interest in complementary and alternative medicine (CAM), particularly for adverse effects of adjuvant endocrine treatment — e.g., with letrozole. Letrozole often induces myalgia/limb pain and arthralgia, with potential noncompliance and treatment termination. This analysis investigated whether CAM before aromatase inhibitor (AI) therapy is associated with pain development and the intensity of AI-induced musculoskeletal syndrome (AIMSS) during the first year of treatment. Patients and methods The multicenter phase IV PreFace study evaluated letrozole therapy in postmenopausal, hormone receptor–positive patients with early BC. Patients were asked about CAM use before, 6 months after, and 12 months after treatment started. They recorded pain every month for 1 year in a diary including questions about pain and numeric pain rating scales. Data were analyzed for patients who provided pain information for all time points. Results Of 1396 patients included, 901 (64.5%) had used CAM before AI treatment. Throughout the observation period, patients with CAM before AI treatment had higher pain values, for both myalgia/limb pain and arthralgia, than non-users. Pain increased significantly in both groups over time, with the largest increase during the first 6 months. No significant difference of pain increase was noted regarding CAM use. Conclusions CAM use does not prevent or improve the development of AIMSS. Pain intensity was generally greater in the CAM group. Therefore, because of the risk of non-compliance and treatment discontinuation due to the development of higher pain levels, special attention must be paid to patient education and aftercare in these patients. Pain levels of myalgia/limb pain and arthralgia increase under letrozole intake. Within one year pain levels increase in both, CAM users as well as non-CAM users. In CAM users pain levels were higher at all time points than in non-CAM users. The greatest increase of pain levels was noted in the first six treatment months. CAM does not prevent or improve the development of myalgia/limb pain and arthralgia.
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Affiliation(s)
- C C Hack
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - L Häberle
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - B Volz
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C R Loehberg
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; St. Theresien Hospital, Nuremberg, Germany
| | - A D Hartkopf
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - C-B Walter
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | - A Fridman
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - W Malter
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany
| | - R Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - O Hoffmann
- Department of Gynecology, Essen University Hospital, Essen, Germany
| | - S Kuemmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - B Martin
- Tuttlingen Clinic, Tuttlingen, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - H Graf
- Helios Clinics Meiningen, Meiningen, Germany
| | - C Wolf
- Ulm Medical Center, Ulm, Germany
| | - M P Lux
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C M Bayer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Rauh
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - K Almstedt
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Department of Gynecology, Mainz University Hospital, Mainz, Germany
| | - P Gass
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - F Heindl
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Brodkorb
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - L Willer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Lindner
- Agaplesion Diakonie Clinic Hamburg, Hamburg, Germany
| | - H-C Kolberg
- Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
| | - P Krabisch
- Department of Gynecology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - M Weigel
- Department of Gynecology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - D Steinfeld-Birg
- Gynecologic Onocologic Practice Steinfeld-Birg, Augsburg, Germany
| | - A Kohls
- Protestant County Hospital of Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - C Brucker
- Department of Gynecology and Obstetrics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - V Schulz
- Gynecologic Practice Abts+partner, Kiel, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - V Pelzer
- Department of Gynecology, GFO Clinics Bonn, Bonn, Germany
| | - B Rack
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - M W Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, University of Tübingen, Tübingen, Germany; Department of Gynecology, Heinrich Heine University of Dusseldorf, Dusseldorf, Germany
| | - A Rody
- Department of Gynecology, Campus Lübeck, Schleswig-Holstein University Hospital, Schleswig-Holstein, Germany
| | - N Maass
- Department of Gynecology, Campus Kiel, Schleswig-Holstein University Hospital, Schleswig-Holstein, Germany
| | - A Hein
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - P A Fasching
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - N Nabieva
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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Koch MC, Lermann J, van de Roemer N, Renner SK, Burghaus S, Hackl J, Dittrich R, Kehl S, Oppelt PG, Hildebrandt T, Hack CC, Pöhls UG, Renner SP, Thiel FC. Clarifications concerning the commentary “Published analysis of contraceptive effectiveness of Daysy and DaysyView app is fatally flawed”. Reprod Health 2019; 16:83. [PMID: 31208442 PMCID: PMC6572732 DOI: 10.1186/s12978-019-0746-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Koch MC, Lermann J, van de Roemer N, Renner SK, Burghaus S, Hackl J, Dittrich R, Kehl S, Oppelt PG, Hildebrandt T, Hack CC, Pöhls UG, Renner SP, Thiel FC. Retraction Note: Improving usability and pregnancy rates of a fertility monitor by an additional mobile application: results of a retrospective efficacy study of Daysy and DaysyView app. Reprod Health 2019; 16:54. [PMID: 31088503 PMCID: PMC6515608 DOI: 10.1186/s12978-019-0728-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Martin C Koch
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany.
| | - Johannes Lermann
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Niels van de Roemer
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Simone K Renner
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Stefanie Burghaus
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Janina Hackl
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Ralf Dittrich
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Patricia G Oppelt
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Thomas Hildebrandt
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Caroline C Hack
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Uwe G Pöhls
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Stefan P Renner
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Falk C Thiel
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
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Gaß P, Emons J, Bani MR, Wunderle M, Sell C, Preuss C, Rauh C, Schrauder MG, Jud SM, Hack CC, Adler W, Schulz-Wendtland R, Beckmann MW, Fasching PA, Lux MP. The diagnostic accuracy of breast medical tactile examiners (MTE) – A first prospective monocentric study. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- P Gaß
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - J Emons
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - MR Bani
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - M Wunderle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - C Sell
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - C Preuss
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - C Rauh
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - MG Schrauder
- Department of Gynecology and Obstetrics, Aschaffenburg, Deutschland
| | - SM Jud
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - CC Hack
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - W Adler
- Institute of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Deutschland
| | - R Schulz-Wendtland
- Institute of Diagnostic Radiology, Erlangen University Hospital, Erlangen, Deutschland
| | - MW Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - PA Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - MP Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
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Brendle-Behnisch AM, Arkudas A, Bani MR, Jud SM, Schrauder MG, Rauh C, Hack CC, Horch RE, Beckmann MW, Lux MP. Langfristige Kosteneffektivität der Mammareduktionsplastik bei Patientinnen mit Makromastie aus Sicht der Kostenträger und der Gesellschaft. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- AM Brendle-Behnisch
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - A Arkudas
- Plastisch- und Handchirurgische Klinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - MR Bani
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - SM Jud
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - MG Schrauder
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - C Rauh
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - CC Hack
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - RE Horch
- Plastisch- und Handchirurgische Klinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - MW Beckmann
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - MP Lux
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
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Häberle L, Erber R, Gaß P, Hein A, Jud SM, Lux MP, Langemann H, Rauh C, Hack CC, Schulz-Wendtland R, Hartmann A, Beckmann MW, Fasching PA. Prädiktionsmodelle zur Vorhersage von pathologischer Komplettremission bei Brustkrebspatientinnen nach neoadjuvanter Chemotherapie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- L Häberle
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - R Erber
- Universitätsklinikum Erlangen, Pathologisches Institut, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - P Gaß
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - A Hein
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - SM Jud
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - MP Lux
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - H Langemann
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - C Rauh
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - CC Hack
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - R Schulz-Wendtland
- Universitätsklinikum Erlangen, Radiologisches Institut, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - A Hartmann
- Universitätsklinikum Erlangen, Pathologisches Institut, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - MW Beckmann
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - PA Fasching
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
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10
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Huebner H, Erber R, Würfel F, Hein A, Lux MP, Jud S, Kremer A, Kranich H, Mackensen A, Häberle L, Hack CC, Rauh C, Wunderle M, Gaß P, Rabizadeh S, Brandl AL, Langemann H, Volz B, Nabieva N, Schulz-Wendtland R, Dudziak D, Beckmann MW, Hartmann A, Fasching PA, Rübner M. TILGen: Eine Studie zur Untersuchung immunonkologischer Marker für die Behandlung des Mammakarzinoms – Erste Ergebnisse zum Einfluss Tumor-infiltrierender Lymphozyten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- H Huebner
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - R Erber
- Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - F Würfel
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Hein
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - MP Lux
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - S Jud
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Kremer
- Medizinische Klinik 5, Hämatologie und Onkologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - H Kranich
- Medizinische Klinik 5, Hämatologie und Onkologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Mackensen
- Medizinische Klinik 5, Hämatologie und Onkologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - L Häberle
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - CC Hack
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - C Rauh
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - M Wunderle
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - P Gaß
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - S Rabizadeh
- NantOmics, LLC, Santa Cruz, Vereinigte Staaten von Amerika
| | - AL Brandl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - H Langemann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - B Volz
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - N Nabieva
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - R Schulz-Wendtland
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - D Dudziak
- Dermatologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - MW Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Hartmann
- Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - PA Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - M Rübner
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
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11
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Poehls UG, Hack CC, Ekici AB, Beckmann MW, Fasching PA, Ruebner M, Huebner H. Saliva samples as a source of DNA for high throughput genotyping: an acceptable and sufficient means in improvement of risk estimation throughout mammographic diagnostics. Eur J Med Res 2018; 23:20. [PMID: 29703267 PMCID: PMC5921411 DOI: 10.1186/s40001-018-0318-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/10/2018] [Indexed: 01/04/2023] Open
Abstract
Background Breast cancer screening programs seem to be an insufficient tool for women at high genetic risk for breast cancer. These women are not adequately monitored yet. Genetic testing may improve clearly the quality of breast cancer prevention programs. At present, blood samples are favored for obtaining high-quality DNA; however, DNA can also be obtained by collecting saliva. The aim of this study was, on the one hand, to determine whether saliva sampling is a practicable means to obtain sufficient quantity and quality of DNA and, on the other hand, whether it is accepted by patients throughout mammographic diagnostics. Methods 67 consecutive women with diagnostic need for mammography with or without a family history for breast cancer were asked for their basic willingness to undergo a genetic testing by saliva sample in addition to standard diagnostics. Saliva samples were analyzed in terms of DNA quantity and quality. Results 64 (95.6%) women agreed to provide a saliva sample; 3 of them denied participation. And even 63 out of 64 (98.4%) were interested in their specific results. 45 out of 64 samples contained a DNA concentration above 50 ng/µl, 12 samples were between 25 and 50 ng/µl and only 7 of them were under 25 ng/µl with the standard extraction procedure. Conclusion A high number of patients seem to accept salvia samples as a risk assessment tool in breast diagnostics and are interested in their specific risk situation. At the same time, it could be demonstrated that it is an effective way to provide high-quality DNA for breast cancer gene analysis. However, it remains to be shown whether it would be possible to integrate it with the same acceptance in a nationwide breast cancer screening program. Electronic supplementary material The online version of this article (10.1186/s40001-018-0318-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- U G Poehls
- Women's Health Center Wuerzburg, Kaiserstrasse 26, 97070, Würzburg, Germany.,Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - C C Hack
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - A B Ekici
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 10, 91054, Erlangen, Germany
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - M Ruebner
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - H Huebner
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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12
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Nabieva N, Fehm T, Häberle L, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Popovic M, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauss T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Hack CC, Schmidt K, Belleville E, Brucker SY, Kümmel S, Beckmann MW, Wallwiener D, Hadji P, Fasching PA. Influence of side-effects on early therapy persistence with letrozole in post-menopausal patients with early breast cancer: Results of the prospective EvAluate-TM study. Eur J Cancer 2018; 96:82-90. [PMID: 29679775 DOI: 10.1016/j.ejca.2018.03.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endocrine treatment (ET) with an aromatase inhibitor (AI) is the treatment of choice in post-menopausal patients with hormone receptor-positive early breast cancer (EBC). However, adverse events (AEs) often lead to treatment discontinuation. This analysis aimed to identify side-effects that lead to patients failing to persist with letrozole treatment. PATIENTS AND METHODS Post-menopausal hormone receptor-positive EBC patients starting ET with letrozole were enroled in EvAluate-TM, a non-interventional study. Information regarding treatment compliance and persistence was gathered in months 6 and 12. Persistence was defined as the time from 30 d after the start to the end of treatment. The influence on persistence of musculoskeletal syndrome, menopausal disorder, sleep disorder and other AEs within the first 30 d was analysed using Cox regression analyses. RESULTS Among 3887 patients analysed, the persistence rate after 12 months was >85%. In all, 568 patients (14.6%) discontinued the treatment, 358 of whom (63.0%) did so only because of side-effects. The main AEs influencing persistence were musculoskeletal symptoms (hazard ratio [HR] 2.55; 95% confidence interval [CI], 1.90-3.42), sleep disorders (HR 1.95; 95% CI, 1.41-2.70) and other AEs (HR 2.03; 95% CI, 1.51-2.73). Menopausal disorder was not associated with non-persistence (HR 1.17; 95% CI, 0.74-1.84). CONCLUSIONS These results suggest that side-effects of AIs such as musculoskeletal syndrome and sleep disorder lead to ET discontinuation within the first treatment year in significant numbers of EBC patients. Compliance programmes adapted for subgroups that are at risk for early non-persistence might help to ensure the recommended therapy duration. CLINICAL TRIALS NUMBER CFEM345DDE19.
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Affiliation(s)
- N Nabieva
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - L Häberle
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - J de Waal
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - M Rezai
- Luisen-Hospital Düsseldorf, Düsseldorf, Germany
| | - B Baier
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | | | | | - M Warm
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; Breast Center, Clinics of Cologne GmbH, Holweide, Cologne, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; University Hospital Munich (LMU), Dept. of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich, Germany
| | - R Wuerstlein
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; University Hospital Munich (LMU), Dept. of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich, Germany
| | - J-U Deuker
- Vinzenz-Hospital Hannover GmbH, Hannover, Germany
| | - P Dall
- Department of Gynecology, Lüneburg Clinic, Lüneburg, Germany
| | - B Richter
- Elbland Clinics, Meissen-Radebeul, Germany
| | - G Wachsmann
- County Hospital of Böblingen, Böblingen, Germany
| | - C Brucker
- Department of Gynecology, University Hospital, Paracelsus Private Medical University of Nuremberg, Nuremberg, Germany
| | - J W Siebers
- Department of Gynecology, St. Josef's Hospital, Offenburg, Germany
| | - M Popovic
- Department of Gynecology, Bayreuth Clinic GmbH, CCC ER-EMN, Bayreuth, Germany
| | - T Kuhn
- Karl-Olga-Hospital Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - C Wolf
- Medical Center Ulm, Ulm, Germany
| | - H-W Vollert
- Friedrichshafen Clinic, Friedrichshafen, Germany
| | - G-P Breitbach
- Department of Gynecology, Neunkirchen Clinic, Neunkirchen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - R Landthaler
- Gynecological Medical Practice of the County Hospital of Krumbach, Krumbach, Germany
| | - A Kohls
- Evangelic County Hospital Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - D Rezek
- Marien-Hospital Wesel, Wesel, Germany
| | - T Noesselt
- Department of Gynecology of the County Hospital of Hameln, Hameln, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - S Henschen
- Johanniter Hospital Genthin Stendal gGmbH, Hansestadt Stendal, Germany
| | - T Praetz
- Caritas-Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - V Heyl
- Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - T Kühn
- Department of Gynecology, Esslingen Clinics a.N., Esslingen, Germany
| | - T Krauss
- Department of Gynecology Passau, Passau, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - A Hohn
- County Hospital Kiel GmbH, Kiel, Germany
| | - H Tesch
- Oncology Bethanien Frankfurt, Frankfurt, Germany
| | - C Mundhenke
- Department of Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Hein
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C C Hack
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - K Schmidt
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | | | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - S Kümmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - M W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - D Wallwiener
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - P Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - P A Fasching
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
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Koch MC, Lermann J, van de Roemer N, Renner SK, Burghaus S, Hackl J, Dittrich R, Kehl S, Oppelt PG, Hildebrandt T, Hack CC, Pöhls UG, Renner SP, Thiel FC. Improving usability and pregnancy rates of a fertility monitor by an additional mobile application: results of a retrospective efficacy study of Daysy and DaysyView app. Reprod Health 2018; 15:37. [PMID: 29499716 PMCID: PMC5833051 DOI: 10.1186/s12978-018-0479-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 02/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Daysy is a fertility monitor that uses the fertility awareness method by tracking and analyzing the individual menstrual cycle. In addition, Daysy can be connected to the application DaysyView to transfer stored personal data from Daysy to a smartphone or tablet (IOS, Android). This combination is interesting because as it is shown in various studies, the use of apps is increasing patients´ focus on their disease or their health behavior. The aim of this study was to investigate if by the additional use of an App and thereby improved usability of the medical device, it is possible to enhance the typical-use related as well as the method-related pregnancy rates. RESULT In the resultant group of 125 women (2076 cycles in total), 2 women indicated that they had been unintentionally pregnant during the use of the device, giving a typical-use related Pearl-Index of 1.3. Counting only the pregnancies which occurred as a result of unprotected intercourse during the infertile (green) phase, we found 1 pregnancy, giving a method-related Pearl-Index of 0.6. Calculating the pregnancy rate resulting from continuous use and unprotected intercourse exclusively on green days, gives a perfect-use Pearl-Index of 0.8. CONCLUSION It seems that combining a specific biosensor-embedded device (Daysy), which gives the method a very high repeatable accuracy, and a mobile application (DaysyView) which leads to higher user engagement, results in higher overall usability of the method.
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Affiliation(s)
- Martin C Koch
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany.
| | - Johannes Lermann
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | | | - Simone K Renner
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Stefanie Burghaus
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Janina Hackl
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Ralf Dittrich
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Sven Kehl
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Patricia G Oppelt
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Thomas Hildebrandt
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Caroline C Hack
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Uwe G Pöhls
- Praxis, Kaiserstraße 26, 97070, Würzburg, Germany
| | - Stefan P Renner
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Falk C Thiel
- Klinik am Eichert, Frauenklinik, Eichertstraße 3, 73035, Göppingen, Germany
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Schnürch HG, Ackermann S, Alt CD, Barinoff J, Böing C, Dannecker C, Gieseking F, Günthert A, Hantschmann P, Horn LC, Kürzl R, Mallmann P, Marnitz S, Mehlhorn G, Hack CC, Koch MC, Torsten U, Weikel W, Wölber L, Hampl M. Diagnosis, Therapy and Follow-up Care of Vulvar Cancer and its Precursors. Guideline of the DGGG and DKG (S2k-Level, AWMF Registry Number 015/059, November 2015. Geburtshilfe Frauenheilkd 2016; 76:1035-1049. [PMID: 27765958 DOI: 10.1055/s-0042-103728] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: This is an official guideline, published and coordinated by the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO, Study Group for Gynecologic Oncology) of the Deutsche Krebsgesellschaft (DKG, German Cancer Society) and the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG, German Society for Gynecology and Obstetrics). The number of cases with vulvar cancer is on the rise, but because of the former rarity of this condition and the resulting lack of literature with a high level of evidence, in many areas knowledge of the optimal clinical management still lags behind what would be required. This updated guideline aims to disseminate the most recent recommendations, which are much clearer and more individualized, and is intended to create a basis for the assessment and improvement of quality care in hospitals. Methods: This S2k guideline was drafted by members of the AGO Committee on Vulvar and Vaginal Tumors; it was developed and formally completed in accordance with the structured consensus process of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). Recommendations: 1. The incidence of disease must be taken into consideration. 2. The diagnostic pathway, which is determined by the initial findings, must be followed. 3. The clinical and therapeutic management of vulvar cancer must be done on an individual basis and depends on the stage of disease. 4. The indications for sentinel lymph node biopsy must be evaluated very carefully. 5. Follow-up and treatment for recurrence must be adapted to the individual case.
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Affiliation(s)
| | | | - C D Alt
- Institut für Diagnostische und Interventionelle Radiologie, Universität Düsseldorf, Düsseldorf
| | - J Barinoff
- Klinik für Gynäkologie und Geburtshilfe, Markus Krankenhaus, Frankfurt am Main
| | - C Böing
- Katholisches Klinikum Oberhausen, Frauenklinik St. Clemens-Hospital, Oberhausen
| | - C Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität München, Campus Großhadern, München, Munich
| | - F Gieseking
- Dysplasiezentrum in der Frauenarztpraxis Heussweg, Hamburg
| | - A Günthert
- Frauenklinik Luzerner Kantonsspital, Lucerne, Switzerland
| | - P Hantschmann
- Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting - Burghausen, Altötting
| | - L C Horn
- Institut für Pathologie des Universitätsklinikums Leipzig, Leipzig
| | - R Kürzl
- ehem. Universitätsfrauenklinik Maistraße, Munich
| | - P Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität Köln, Cologne
| | - S Marnitz
- Klinik und Poliklinik für Radioonkologie und Strahlentherapie der Universität Köln, Cologne
| | - G Mehlhorn
- Universitätsfrauenklinik Erlangen, Erlangen
| | - C C Hack
- Universitätsfrauenklinik Erlangen, Erlangen
| | - M C Koch
- Universitätsfrauenklinik Erlangen, Erlangen
| | - U Torsten
- Klinik für Gynäkologie und Zentrum für Beckenbodenerkrankungen, Vivantes Klinikum Neukölln, Berlin
| | - W Weikel
- Klinik für Gynäkologie und gynäkologische Onkologie, Universitätsfrauenklinik Mainz, Mainz
| | - L Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - M Hampl
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf, Düsseldorf
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15
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Theuser AK, Hüttner NBM, Hackl J, Fasching PA, Beckmann MW, Hack CC. Einsatz von integrativen Heilmethoden durch Patientinnen mit gynäkologischen Tumoren – Analyse in der Spezialsprechstunde für Integrative Medizin. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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16
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Brendle-Behnisch AM, Schrauder MG, Bani MR, Rauh C, Hack CC, Beckmann MW, Lux MP. Langfristige Kosteneffektivität der Mammareduktionsplastik bei Patientinnen mit Makromastie aus Sicht der Kostenträger und der Gesellschaft. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Hack CC, Fasching PA, Fehm T, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Fersis N, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauß T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Rauh C, Bayer CM, Jacob A, Schmidt K, Belleville E, Hadji P, Brucker SY, Wallwiener D, Paepke D, Kümmel S, Beckmann MW. Interest in integrative medicine among postmenopausal hormone receptor-positive breast cancer patients receiving letrozole treatment in the EvAluate-TM study. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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18
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Häberle L, Hack CC, Heusinger K, Wagner F, Heindl F, Gaß P, Jud SM, Franz D, Vachon C, Uder M, Beckmann MW, Schulz-Wendtland R, Wittenberg T, Fasching PA. Die Verwendung automatisch generierter Texturmerkmale zur Bestimmung der Wahrscheinlichkeit, dass ein mit Ultraschall entdeckter Tumor auf dem Mammogramm übersehen wird. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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19
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Kalder M, Müller T, Fischer D, Müller A, Bader W, Beckmann MW, Brucker C, Hack CC, Hanf V, Hasenburg A, Hein A, Jud S, Kiechle M, Klein E, Paepke D, Rotmann A, Schütz F, Dobos G, Voiß P, Kümmel S. A Review of Integrative Medicine in Gynaecological Oncology. Geburtshilfe Frauenheilkd 2016; 76:150-155. [PMID: 26941447 DOI: 10.1055/s-0042-100208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
In recent years complementary and alternative medicine (CAM) has increasingly been the focus of international research. Numerous subsidised trials (7903) and systematic reviews (651) have been published, and the evidence is starting to be integrated into treatment guidelines. However, due to insufficient evidence and/or insufficient good quality evidence, this has mostly not translated to practice recommendations in reviews by the Cochrane collaboration gynaecology group. There is nevertheless a not insignificant number of CAM providers and users. The percentage of oncology patients who use CAM varies between 5 and 90 %. Doctors have been identified as the main providers of CAM. Half of gynaecologists offer CAM because of personal conviction or on suggestion from colleagues. This must be viewed in a critical light, since CAM is mostly practiced without appropriate training, often without sufficient evidence for a given method - and where evidence exists, practice guidelines are lacking - and lack of safety or efficacy testing. The combination of patient demand and lucrativeness for doctors/alternative medicine practitioners, both based on supposed effectiveness CAM, often leads to its indiscriminate use with uncertain outcomes and significant cost for patients. On the other hand there is published, positive level I evidence for a number of CAM treatment forms. The aim of this article is therefore to review the available evidence for CAM in gynaecological oncology practice. The continued need for research is highlighted, as is the need to integrate practices supported by good evidence into conventional gynaecological oncology.
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Affiliation(s)
- M Kalder
- Klinik für Frauenheilkunde und Geburtshilfe, Philipps-Universität Marburg, Marburg
| | - T Müller
- AGAPLESION Markus Krankenhaus, Abteilung für Gynäkologie und Geburtshilfe, Frankfurt am Main
| | - D Fischer
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Ernst von Bergmann, Potsdam
| | - A Müller
- Frauenklinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe
| | - W Bader
- Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld
| | - M W Beckmann
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - C Brucker
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - C C Hack
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - V Hanf
- Frauenklinik und Brustzentrum Nathanstift, Klinikum Fürth, Fürth
| | - A Hasenburg
- Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Universitätsmedizin Mainz, Mainz
| | - A Hein
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - S Jud
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - M Kiechle
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - E Klein
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - D Paepke
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - A Rotmann
- Praxis für Frauenheilkunde, Geburtshilfe und Naturheilkunde, Rodgau
| | - F Schütz
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg, Heidelberg
| | - G Dobos
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
| | - P Voiß
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
| | - S Kümmel
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
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20
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Hack CC, Voiß P, Lange S, Paul AE, Conrad S, Dobos GJ, Beckmann MW, Kümmel S. Local and Systemic Therapies for Breast Cancer Patients: Reducing Short-term Symptoms with the Methods of Integrative Medicine. Geburtshilfe Frauenheilkd 2015; 75:675-682. [PMID: 26257404 DOI: 10.1055/s-0035-1557748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 06/21/2015] [Accepted: 06/21/2015] [Indexed: 12/25/2022] Open
Abstract
With improved prognosis due to advances in the diagnosis and therapy of breast cancer, physicians and therapists now focus on aspects such as quality of life and the management of side effects from breast cancer treatment. Therapy- and disease-related side effects often reduce the patient's quality of life and can place a further burden on patients, with non-compliance or discontinuation of therapy a potential consequence. Study data have shown that therapy- and disease-related side effects can be reduced using the methods of integrative medicine. Reported benefits include improving patients' wellbeing and quality of life, reducing stress, and improving patients' mood, sleeping patterns and capacity to cope with disease. Examining the impact of integrative medicine on the side effects of cancer treatment would be beyond the scope of this review. This article therefore looks at short-term side effects of cancer treatment which are usually temporary and occur during or after local and systemic therapy. The focus is on mind-body medicine, acupuncture and classic naturopathic treatments developed by Sebastian Kneipp as complementary therapies. The latter includes hydrotherapy, phytotherapy, nutritional therapy, exercise therapy and a balanced lifestyle.
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Affiliation(s)
- C C Hack
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - P Voiß
- Klinik für Naturheilkunde und Integrative Medizin, Kliniken Essen Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen ; Brustzentrum, Kliniken Essen Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen
| | - S Lange
- Klinik für Naturheilkunde und Integrative Medizin, Kliniken Essen Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen
| | - A E Paul
- Klinik für Naturheilkunde und Integrative Medizin, Kliniken Essen Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen
| | - S Conrad
- Klinik für Naturheilkunde und Integrative Medizin, Kliniken Essen Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen
| | - G J Dobos
- Klinik für Naturheilkunde und Integrative Medizin, Kliniken Essen Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen
| | - M W Beckmann
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - S Kümmel
- Brustzentrum, Kliniken Essen Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen
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21
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Hack CC, Hüttner NBM, Fasching PA, Beckmann MW. Development and Validation of a Standardized Questionnaire and Standardized Diary for Use in Integrative Medicine Consultations in Gynecologic Oncology. Geburtshilfe Frauenheilkd 2015; 75:377-383. [PMID: 26028695 DOI: 10.1055/s-0035-1545850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 03/07/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022] Open
Abstract
Introduction: Use of complementary and alternative medicine (CAM) in diagnoses is not standardized and is very heterogeneous. There are few published standards on integrative medicine consultations or CAM-specific validated follow-up questionnaires. The aim of this study was to develop a standard for integrative medicine consultations, a patient questionnaire which could be used as a basis for medical decisions, and a diary to evaluate the course of the integrative therapy. Patients and Methods: Between June 2013 and September 2014 a standardized integrative medicine consultation in gynecologic oncology was developed and implemented at the Department of Gynecology and Obstetrics of Erlangen University Hospital. A standard operating procedure for consultations was developed; the necessary instruments were developed and validated. Results: Overall patient assessment of the integrative medicine questionnaire and the integrative medicine diary with regard to the time required for completion, comprehensibility, complexity and functionality was positive. Patients evaluated the standardized overall concept of the integrative medicine consultation and its instruments as suitable. Conclusion: Our team is one of the first study groups to develop, validate and publish a standard procedure for integrative medicine consultations. In future, the standard operating procedure for integrative medicine procedures of the Department of Gynecology and Obstetrics of Erlangen University Hospital could be introduced in other hospitals and certified breast cancer centers and gynecologic cancer centers. This would offer patients maximum security and a standardized quality of care in integrative medicine.
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Affiliation(s)
- C C Hack
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - N B M Hüttner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
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22
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Hildebrandt T, Kraml F, Wagner S, Hack CC, Thiel FC, Kehl S, Winkler M, Frobenius W, Faschingbauer F, Beckmann MW, Lux MP. Impact of Patient and Procedure Mix on Finances of Perinatal Centres - Theoretical Models for Economic Strategies in Perinatal Centres. Geburtshilfe Frauenheilkd 2014; 73:783-791. [PMID: 24771932 DOI: 10.1055/s-0033-1350650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 05/30/2013] [Accepted: 06/01/2013] [Indexed: 10/26/2022] Open
Abstract
Introduction: In Germany, cost and revenue structures of hospitals with defined treatment priorities are currently being discussed to identify uneconomic services. This discussion has also affected perinatal centres (PNCs) and represents a new economic challenge for PNCs. In addition to optimising the time spent in hospital, the hospital management needs to define the "best" patient mix based on costs and revenues. Method: Different theoretical models were proposed based on the cost and revenue structures of the University Perinatal Centre for Franconia (UPF). Multi-step marginal costing was then used to show the impact on operating profits of changes in services and bed occupancy rates. The current contribution margin accounting used by the UPF served as the basis for the calculations. The models demonstrated the impact of changes in services on costs and revenues of a level 1 PNC. Results: Contribution margin analysis was used to calculate profitable and unprofitable DRGs based on average inpatient cost per day. Nineteen theoretical models were created. The current direct costing used by the UPF and a theoretical model with a 100 % bed occupancy rate were used as reference models. Significantly higher operating profits could be achieved by doubling the number of profitable DRGs and halving the number of less profitable DRGs. Operating profits could be increased even more by changing the rates of profitable DRGs per bed occupancy. The exclusive specialisation on pathological and high-risk pregnancies resulted in operating losses. All models which increased the numbers of caesarean sections or focused exclusively on c-sections resulted in operating losses. Conclusion: These theoretical models offer a basis for economic planning. They illustrate the enormous impact potential changes can have on the operating profits of PNCs. Level 1 PNCs require high bed occupancy rates and a profitable patient mix to cover the extremely high costs incurred due to the services they are legally required to offer. Based on our theoretical models it must be stated that spontaneous vaginal births (not caesarean sections) were the most profitable procedures in the current DRG system. Overall, it currently makes economic sense for level I PNCs to treat as many low-risk pregnancies and neonates as possible to cover costs.
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Affiliation(s)
- T Hildebrandt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
| | - F Kraml
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
| | - S Wagner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
| | - C C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
| | - F C Thiel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
| | - S Kehl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
| | - M Winkler
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
| | - W Frobenius
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
| | - F Faschingbauer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
| | - M W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
| | - M P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
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23
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Hack CC, Häberle L, Geisler K, Schulz-Wendtland R, Hartmann A, Fasching PA, Uder M, Wachter DL, Jud SM, Loehberg CR, Lux MP, Rauh C, Beckmann MW, Heusinger K. Mammographic Density and Prediction of Nodal Status in Breast Cancer Patients. Geburtshilfe Frauenheilkd 2013; 73:136-141. [PMID: 24771910 DOI: 10.1055/s-0032-1328291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 02/14/2013] [Accepted: 02/15/2013] [Indexed: 12/15/2022] Open
Abstract
Aim: Nodal status remains one of the most important prognostic factors in breast cancer. The cellular and molecular reasons for the spread of tumor cells to the lymph nodes are not well understood and there are only few predictors in addition to tumor size and multifocality that give an insight into additional mechanisms of lymphatic spread. Aim of our study was therefore to investigate whether breast characteristics such as mammographic density (MD) add to the predictive value of the presence of lymph node metastases in patients with primary breast cancer. Methods: In this retrospective study we analyzed primary, metastasis-free breast cancer patients from one breast center for whom data on MD and staging information were available. A total of 1831 patients were included into this study. MD was assessed as percentage MD (PMD) using a semiautomated method and two readers for every patient. Multiple logistic regression analyses with nodal status as outcome were used to investigate the predictive value of PMD in addition to age, tumor size, Ki-67, estrogen receptor (ER), progesterone receptor (PR), grading, histology, and multi-focality. Results: Multifocality, tumor size, Ki-67 and grading were relevant predictors for nodal status. Adding PMD to a prediction model which included these factors did not significantly improve the prediction of nodal status (p = 0.24, likelihood ratio test). Conclusion: Nodal status could be predicted quite well with the factors multifocality, tumor size, Ki-67 and grading. PMD does not seem to play a role in the lymphatic spread of tumor cells. It could be concluded that the amount of extracellular matrix and stromal cell content of the breast which is reflected by MD does not influence the probability of malignant breast cells spreading from the primary tumor to the lymph nodes.
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Affiliation(s)
- C C Hack
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - L Häberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - K Geisler
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - R Schulz-Wendtland
- Institut für gynäkologische Radiologie, Universitätsklinikum Erlangen, Erlangen
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Erlangen
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - M Uder
- Institut für gynäkologische Radiologie, Universitätsklinikum Erlangen, Erlangen
| | - D L Wachter
- Institute of Pathology, University Hospital Erlangen, Erlangen
| | - S M Jud
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - C R Loehberg
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - M P Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - C Rauh
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - K Heusinger
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
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24
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Rauh C, Hack CC, Häberle L, Hein A, Engel A, Schrauder MG, Fasching PA, Jud SM, Ekici AB, Loehberg CR, Meier-Meitinger M, Ozan S, Schulz-Wendtland R, Uder M, Hartmann A, Wachter DL, Beckmann MW, Heusinger K. Percent Mammographic Density and Dense Area as Risk Factors for Breast Cancer. Geburtshilfe Frauenheilkd 2012; 72:727-733. [PMID: 25258465 DOI: 10.1055/s-0032-1315129] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 06/28/2012] [Accepted: 06/29/2012] [Indexed: 10/28/2022] Open
Abstract
Purpose: Mammographic characteristics are known to be correlated to breast cancer risk. Percent mammographic density (PMD), as assessed by computer-assisted methods, is an established risk factor for breast cancer. Along with this assessment the absolute dense area (DA) of the breast is reported as well. Aim of this study was to assess the predictive value of DA concerning breast cancer risk in addition to other risk factors and in addition to PMD. Methods: We conducted a case control study with hospital-based patients with a diagnosis of invasive breast cancer and healthy women as controls. A total of 561 patients and 376 controls with available mammographic density were included into this study. We describe the differences concerning the common risk factors BMI, parital status, use of hormone replacement therapy (HRT) and menopause between cases and controls and estimate the odds ratios for PMD and DA, adjusted for the mentioned risk factors. Furthermore we compare the prediction models with each other to find out whether the addition of DA improves the model. Results: Mammographic density and DA were highly correlated with each other. Both variables were as well correlated to the commonly known risk factors with an expected direction and strength, however PMD (ρ = -0.56) was stronger correlated to BMI than DA (ρ = -0.11). The group of women within the highest quartil of PMD had an OR of 2.12 (95 % CI: 1.25-3.62). This could not be seen for the fourth quartile concerning DA. However the assessment of breast cancer risk could be improved by including DA in a prediction model in addition to common risk factors and PMD. Conclusions: The inclusion of the parameter DA into a prediction model for breast cancer in addition to established risk factors and PMD could improve the breast cancer risk assessment. As DA is measured together with PMD in the process of computer-assisted assessment of PMD it might be considered to include it as one additional breast cancer risk factor that is obtained from breast imaging.
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Affiliation(s)
- C Rauh
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - C C Hack
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - L Häberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - A Hein
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - A Engel
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - M G Schrauder
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - S M Jud
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - A B Ekici
- Institute of Human Genetics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - C R Loehberg
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | | | - S Ozan
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | | | - M Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Erlangen
| | - D L Wachter
- Institute of Pathology, University Hospital Erlangen, Erlangen
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
| | - K Heusinger
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen
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