Tumorspezifische Substanzen zur Symptomkontrolle in der Palliativmedizin - Entscheidungsfindung und Anwendung
Anticancer therapies in specialized palliative care - decision making processes and therapeutic application
by Xenia von Schoenebeck
Date of Examination:2012-06-18
Date of issue:2012-05-30
Advisor:Dr. Bernd Alt-Epping
Referee:Prof. Dr. Friedemann Nauck
Referee:Prof. Dr. Claudia Binder
Referee:Prof. Dr. Patricia Virsik-Köpp
Persistent Address:
http://dx.doi.org/10.53846/goediss-1534
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Abstract
English
Since the mid-1990s it has been assumed that tumor-modifying substances such as chemotherapeutics and – later on – so-called Targeted Therapies have positive effects on the control of symptoms and the life quality of patients with advanced incurable tumor diseases. By employing a prospective series of case studies (by evaluating surveys, semi-structural interviews and clinical follow-ups) this study analyzed these improvements of the symptom control which up to now have mostly been documented as secondary endpoints. The criteria of evaluation included frequency of medication, clinical benefit, costs, expenditure of time and the decision-making in regard to the therapies applied. With the primary goal of control of symptoms, eleven out of 551 inpatients have been treated with tumor specific substances within the time of surveying (2.0 %). The findings demonstrate that there is a clinical, symptom-correlated benefit for five of these eleven patients with advanced tumor diseases. In contrast, five patients did not benefit at all from the therapy, while this is somehow questionable in the case of one patient. The additional amount of time has been minimal in the case of six (out of the eleven) patients due to simple application and minor toxicity. At the maximum, six days per month have been invested. The median of survival time was 84 days, the costs of medication varied from 320,27 EUR to 90.664,45 EUR. In their decision-making concerning the therapies applied, the treating physicians prioritized a rapid progress, the distinctive wish of the patient, a simple application, and positive experiences which have been made previously in the application of chemotherapeutics in comparable clinical situations. The relevance of these different factors in the specific decision-making processes analyzed by this study therefore mirror the complexity of physicians' decision-making processes in general. The findings of the study hint on the fact that life quality of palliative patients might be improved by the specific application of Targeted Therapies and conventional chemotherapeutics which at the same time have to be combined with a specialized palliative care treatment in a multidisciplinary team. However, to utilize the findings of this study for future therapy concepts throughout the palliative care sector in general, further research is needed.
Keywords: symptom control; palliative care; anticancer therapies
Other Languages
Seit Mitte der 1990er Jahre gibt es
Hinweise darauf, dass tumormodifizierende Substanzen wie
Chemotherapeutika und später auch sog. Targeted Therapies positiv
auf die Symptomkontrolle und Lebensqualität von Patienten mit weit
fortgeschrittenen inkurablen Tumorerkrankungen einwirken. Die
bisher in Studien zumeist als sekundäre Endpunkte dokumentierten
Verbesserungen der Symptomkontrolle sind in der vorliegenden
Untersuchung prospektiv an einer Fallserie von Palliativpatienten
untersucht worden (Fragebögen, semistrukturierte Interviews,
Akteneinsicht). Auswertungskriterien waren die Häufigkeit des
Einsatzes, klinischer Benefit, Kosten, Zeitaufwand und
Therapieentscheidungen. Tumorspezifische Substanzen sind bei elf
von 551 in der Erhebungsphase stationär betreuten Patienten der
Palliativstation mit dem primären Ziel der Symptomkontrolle
angewandt worden (2,0%). Es ließ sich ein klinischer,
symptombezogener Benefit für fünf von elf Patienten mit
fortgeschrittenem Tumorleiden nachweisen. Durch die Therapie
profitierten fünf Patienten nicht, ein weiterer Patient nur
fraglich. Der zusätzliche Zeitaufwand gestaltete sich für sechs von
elf Patienten durch einfache Applikation sowie geringe Toxizität
minimal. Maximal sind sechs Tage monatlich investiert worden. Die
mediane Überlebenszeit lag bei 84 Tagen, die Medikamentenkosten
lagen fallspezifisch zwischen 320,27 Euro bis hin zu 90.664,45 Euro
(durchschnittlich bei 15.014,12 Euro). Bei ihrer
Therapieentscheidung priorisierten die behandelnden
Schlagwörter: Palliativmedizin; Tumorspezifische Substanzen; Symptomkontrolle