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Sappok T, Kowalski C, Zenker M, Weißinger F, Berger AW. [Cancer in people with an intellectual disability in Germany: prevalence, genetics, and care situation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:362-369. [PMID: 38334785 DOI: 10.1007/s00103-024-03837-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
Intellectual disability has a prevalence rate of approximately 1% of the population; in Germany, this is around 0.5-1 million people. The life expectancy of this group of people is reduced, with cancer being one of the most common causes of death (approx. 20%). Overall, the risk of cancer and mortality is increased compared to the general population.Certain genetic syndromes predispose to cancer in this vulnerable group, but associated comorbidities or lifestyle could also be risk factors for cancer. People with cognitive impairments are less likely to attend preventive check-ups, and challenges arise in medical care due to physical, communicative, and interactional characteristics. Optimized cooperation between clinical centers for people with disabilities and the respective cancer centers is required in order to tailor the processes to the individual.In Germany, there is a lack of data on the prevalence of cancer entities and the use and need for healthcare services. There is an urgent need to focus attention on cancer prevention, treatment, and research in the vulnerable and heterogeneous group of people with intellectual disabilities suffering from cancer in order to effectively counteract the increase in cancer-related deaths in this population group.The article summarizes specialist knowledge on cancer in people with an intellectual disability, identifies special features of treatment, presents care structures, and derives specific requirements for clinics and research.
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Affiliation(s)
- Tanja Sappok
- Medizinische Fakultät und Universitätsklinik OWL, Krankenhaus Mara, Universitätsklinik für Inklusive Medizin, Universität Bielefeld, Maraweg 21, 33617, Bielefeld, Deutschland.
| | | | - Martin Zenker
- Medizinische Fakultät, Universitätsklinikum Magdeburg, Institut für Humangenetik, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Florian Weißinger
- Klinik für Innere Medizin, Hämatologie, Onkologie, Stammzelltransplantation, Palliativmedizin, Evangelisches Klinikum Bethel, Bielefeld, Deutschland
| | - Andreas W Berger
- Klinik für Innere Medizin II - Gastroenterologie und gastrointestinale Onkologie, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Deutschland
- Medizinisches Zentrum für Erwachsene mit Behinderungen, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Deutschland
- Universitätsklinikum Ulm, Department für Innere Medizin, Klinik für Innere Medizin I, Universität Ulm, Ulm, Deutschland
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Classen AY, Henze L, von Lilienfeld-Toal M, Maschmeyer G, Sandherr M, Graeff LD, Alakel N, Christopeit M, Krause SW, Mayer K, Neumann S, Cornely OA, Penack O, Weißinger F, Wolf HH, Vehreschild JJ. Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors: 2020 updated guidelines of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO/DGHO). Ann Hematol 2021; 100:1603-1620. [PMID: 33846857 PMCID: PMC8116237 DOI: 10.1007/s00277-021-04452-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/04/2021] [Indexed: 12/11/2022]
Abstract
Hematologic and oncologic patients with chemo- or immunotherapy-related immunosuppression are at substantial risk for bacterial infections and Pneumocystis jirovecii pneumonia (PcP). As bacterial resistances are increasing worldwide and new research reshapes our understanding of the interactions between the human host and bacterial commensals, administration of antibacterial prophylaxis has become a matter of discussion. This guideline constitutes an update of the 2013 published guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). It gives an overview about current strategies for antibacterial prophylaxis in cancer patients while taking into account the impact of antibacterial prophylaxis on the human microbiome and resistance development. Current literature published from January 2012 to August 2020 was searched and evidence-based recommendations were developed by an expert panel. All recommendations were discussed and approved in a consensus conference of the AGIHO prior to publication. As a result, we present a comprehensive update and extension of our guideline for antibacterial and PcP prophylaxis in cancer patients.
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Affiliation(s)
- Annika Y Classen
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Larissa Henze
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Marie von Lilienfeld-Toal
- Department of Hematology and Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany
| | - Georg Maschmeyer
- Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Michael Sandherr
- Specialist Clinic for Haematology and Oncology, Medical Care Center Penzberg, Penzberg, Germany
| | - Luisa Durán Graeff
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Nael Alakel
- Department I of Internal Medicine, Hematology and Oncology, University Hospital Dresden, Dresden, Germany
| | - Maximilian Christopeit
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Stefan W Krause
- Department of Medicine 5 - Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Karin Mayer
- Medical Clinic III for Oncology, Hematology, Immunooncology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - Silke Neumann
- Interdisciplinary Center for Oncology, Wolfsburg, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Olaf Penack
- Medical Department for Hematology, Oncology and Tumor Immunology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Florian Weißinger
- Department for Internal Medicine, Hematology/Oncology, and Palliative Care, Evangelisches Klinikum Bethel v. Bodelschwinghsche Stiftungen Bethel, Bielefeld, Germany
| | - Hans-Heinrich Wolf
- Department IV of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Jörg Janne Vehreschild
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany.
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany.
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Juarso E, Kiehl M, Buchholz M, Weißinger F. [Infections as oncologic emergencies]. Onkologe (Berl) 2019; 26:129-138. [PMID: 32288312 PMCID: PMC7102394 DOI: 10.1007/s00761-019-00691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hintergrund Patienten mit onkologischen Erkrankungen, insbesondere mit hämatologischen Neoplasien, haben ein erhöhtes Risiko für allgemeine Infektionen und spezielle therapieassoziierte Komplikationen mit hoher Morbidität und Mortalität. Die jährliche Inzidenz und Prävalenz für Krebserkrankungen steigt in Deutschland. Moderne Therapieverfahren haben zu einem verbesserten Überleben geführt, jedoch erfordern steigendes Alter, Komorbiditäten und Gebrechlichkeit der Patienten multidisziplinäre Strategien zur Durchführung komplexer Therapiekonzepte und zur Behandlung von deren Komplikationen. Methode Eine selektive Literaturrecherche sowie die Leitlinien der European Society for Medical Oncology (ESMO), der Deutschen Gesellschaft für Hämatologie und Medizinische Onkologie (DGHO), der Arbeitsgemeinschaft Infektionen in der Hämatologie und Onkologie der DGHO (AGIHO) und der American Society of Clinical Oncology (ASCO) sind die Grundlage für den vorliegenden Artikel. Schlussfolgerungen Das Erkennen schwerer Infektionen bei Krebspatienten und deren Unterscheidung von therapieassoziierten Komplikationen stellt eine Herausforderung für den behandelnden Arzt dar. Neutropenisches Fieber ist der häufigste infektiologische Notfall in der Onkologie. Frühzeitige empirische Therapie mit Breitspektrumantibiotika und eskalierende diagnostische Maßnahmen sind notwendig für die erfolgreiche Therapie dieser Risikogruppe. In diesem Beitrag wird eine Reihe von lebensbedrohlichen Infektionen bei immunkompromittierten Patienten diskutiert.
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Affiliation(s)
- Edwin Juarso
- Klinik für Innere Medizin, Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611 Bielefeld, Deutschland
| | - Malte Kiehl
- Klinik für Innere Medizin, Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611 Bielefeld, Deutschland
| | - Markus Buchholz
- Klinik für Innere Medizin, Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611 Bielefeld, Deutschland
| | - Florian Weißinger
- Klinik für Innere Medizin, Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611 Bielefeld, Deutschland
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Lammer F, May L, Martus P, Schroers R, Schlegel U, Hofer S, Bairey O, Schmitz N, Griesinger F, Schmidt-Hieber M, Weißinger F, Reimer P, le Coutre P, Fix P, Hopfer O, Junghanß C, Höffkes H, Heilmeier B, Möhle R, Lange E, Korfel A, Keller U. PROSPECTIVE MULTICENTER REGISTRY FOR SECONDARY CNS INVOLVEMENT IN MALIGNANT LYMPHOMA: AN UPDATE WITH DATA FROM 181 PATIENTS. Hematol Oncol 2019. [DOI: 10.1002/hon.64_2630] [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: 11/07/2022]
Affiliation(s)
- F. Lammer
- Haematology; Oncology, Charité University Medicine; Berlin Germany
| | - L. May
- Haematology; Oncology, Charité University Medicine; Berlin Germany
| | - P. Martus
- Institute of Clinical Epidemiology and Applied Biostatistics; University Hospital Tübingen; Tübingen Germany
| | - R. Schroers
- Haematology; Oncology, Knappschaftskrankenhaus, Ruhr-Universität Bochum; Bochum Germany
| | - U. Schlegel
- Neurology; Knappschaftskrankenhaus, Ruhr-Universität Bochum; Bochum Germany
| | - S. Hofer
- Oncology; Luzerner Kantonsspital; Luzern Switzerland
| | - O. Bairey
- Haematology; Tel Aviv University; Tel Aviv Israel
| | - N. Schmitz
- Haematology; Oncology, Universitätsklinikum Münster; Münster Germany
| | - F. Griesinger
- Haematology; Oncology, Pius Hospital Oldenburg; Oldenburg Germany
| | | | - F. Weißinger
- Haematology; Oncology, Evangelisches Klinikum Bethel; Bielefeld Germany
| | - P. Reimer
- Haematology; Oncology, St. Josef Krankenhaus Essen-Werden; Essen Germany
| | - P. le Coutre
- Haematology; Oncology, Charité University Medicine; Berlin Germany
| | - P. Fix
- Haematology; Oncology, Klinikum Weimar; Weimar Germany
| | - O. Hopfer
- Haematology; Oncology, Klinikum Frankfurt (Oder); Frankfurt (Oder) Germany
| | - C. Junghanß
- Haematology; Oncology, University Rostock; Rostock Germany
| | - H. Höffkes
- Haematology; Oncology, Klinikum Fulda; Fulda Germany
| | - B. Heilmeier
- Oncology; Krankenhaus Barmherzige Brüder; Regensburg Germany
| | - R. Möhle
- Haematology; Oncology, University Hospital Tübingen; Tübingen Germany
| | - E. Lange
- Haematology; Oncology, Evangelisches Krankenhaus Hamm; Hamm Germany
| | - A. Korfel
- Haematology; Oncology, Charité University Medicine; Berlin Germany
| | - U. Keller
- Haematology; Oncology, Charité University Medicine; Berlin Germany
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Moehler M, Gepfner-Tuma I, Maderer A, Thuss-Patience PC, Ruessel J, Hegewisch-Becker S, Wilke H, Al-Batran SE, Rafiyan MR, Weißinger F, Schmoll HJ, Kullmann F, von Weikersthal LF, Siveke JT, Weusmann J, Kanzler S, Schimanski CC, Otte M, Schollenberger L, Koenig J, Galle PR. Sunitinib added to FOLFIRI versus FOLFIRI in patients with chemorefractory advanced adenocarcinoma of the stomach or lower esophagus: a randomized, placebo-controlled phase II AIO trial with serum biomarker program. BMC Cancer 2016; 16:699. [PMID: 27582078 PMCID: PMC5006426 DOI: 10.1186/s12885-016-2736-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/20/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As a multi-targeted anti-angiogenic receptor tyrosine kinase (RTK) inhibitor sunitinib (SUN) has been established for renal cancer and gastrointestinal stromal tumors. In advanced refractory esophagogastric cancer patients, monotherapy with SUN was associated with good tolerability but limited tumor response. METHODS This double-blind, placebo-controlled, multicenter, phase II clinical trial was conducted to evaluate the efficacy, safety and tolerability of SUN as an adjunct to second and third-line FOLFIRI (NCT01020630). Patients were randomized to receive 6-week cycles including FOLFIRI plus sodium folinate (Na-FOLFIRI) once every two weeks and SUN or placebo (PL) continuously for four weeks followed by a 2-week rest period. The primary study endpoint was progression-free survival (PFS). Preplanned serum analyses of VEGF-A, VEGF-D, VEGFR2 and SDF-1α were performed retrospectively. RESULTS Overall, 91 patients were randomized, 45 in each group (one patient withdrew). The main grade ≥3 AEs were neutropenia and leucopenia, observed in 56 %/20 % and 27 %/16 % for FOLFIRI + SUN/FOLFIRI + PL, respectively. Median PFS was similar, 3.5 vs. 3.3 months (hazard ratio (HR) 1.11, 95 % CI 0.70-1.74, P = 0.66) for FOLFIRI + SUN vs. FOLFIRI + PL, respectively. For FOLFIRI + SUN, a trend towards longer median overall survival (OS) compared with placebo was observed (10.4 vs. 8.9 months, HR 0.82, 95 % CI 0.50-1.34, one-sided P = 0.21). In subgroup serum analyses, significant changes in VEGF-A (P = 0.017), VEGFR2 (P = 0.012) and VEGF-D (P < 0.001) serum levels were observed. CONCLUSIONS Although sunitinib combined with FOLFIRI did not improve PFS and response in chemotherapy-resistant gastric cancer, a trend towards better OS was observed. Further biomarker-driven studies with other anti-angiogenic RTK inhibitors are warranted. TRIAL REGISTRATION This study was registered prospectively in the NCT Clinical Trials Registry (ClinicalTrials.gov) under NCT01020630 on November 23, 2009 after approval by the leading ethics committee of the Medical Association of Rhineland-Palatinate, Mainz, in coordination with the participating ethics committees (see Additional file 2) on September 16, 2009.
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Affiliation(s)
- Markus Moehler
- University Medical Center, Johannes Gutenberg-University Mainz, I. Medizinische Klinik und Poliklinik, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Irina Gepfner-Tuma
- University Medical Center, Johannes Gutenberg-University Mainz, I. Medizinische Klinik und Poliklinik, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Annett Maderer
- University Medical Center, Johannes Gutenberg-University Mainz, I. Medizinische Klinik und Poliklinik, Langenbeckstraße 1, 55131 Mainz, Germany
| | | | - Joern Ruessel
- University Hospital Halle (Saale), Halle (Saale), Germany
| | | | | | | | | | | | | | - Frank Kullmann
- Kliniken Nordoberpfalz - Klinikum Weiden, Weiden, Germany
| | | | - Jens T. Siveke
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Jens Weusmann
- University Medical Center, Johannes Gutenberg-University Mainz, I. Medizinische Klinik und Poliklinik, Langenbeckstraße 1, 55131 Mainz, Germany
| | | | | | - Melanie Otte
- Praxisgemeinschaft für Onkologie und Urologie, Wilhelmshaven, Germany
| | | | - Jochem Koenig
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) of the University Medical Center Mainz, Mainz, Germany
| | - Peter R. Galle
- University Medical Center, Johannes Gutenberg-University Mainz, I. Medizinische Klinik und Poliklinik, Langenbeckstraße 1, 55131 Mainz, Germany
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Bokemeyer C, Hallek M, Lüftner D, Weißinger F. Vorwort. Oncol Res Treat 2016; 39 Suppl 2:1. [DOI: 10.1159/000448062] [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: 11/19/2022]
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Lorenzen S, Helbig U, Riera-Knorrenschild J, Haag G, Pohl M, Thuss-Patience P, Bassermann F, Weißinger F, Schnoy E, Becker K, Rüschoff J, Eisenmenger A, Karapanagiotou-Schenkel I, Lordick F. Lapatinib Versus Lapatinib Plus Capecitabine As Second-Line Treatment in Her2-Overexpressing Metastatic Gastro-Esophageal Cancer (Gc): a Randomized Phase Ii Trial of the Arbeitsgemeinschaft Internistische Onkologie (Aio). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.14] [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: 11/13/2022] Open
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