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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
Doctoral thesis
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
crossref-logoPersistent 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
 

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