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U Wedding

Publications and source records attributed to U Wedding.

At least 19 recordsLinked to original sources
PubMed2006

Associations of functional status and depressive symptoms with health-related quality of life in cancer patients.

Associations of functional status (as measured with the Karnofsky Index), depressive symptoms (as assessed with the Beck Depression Inventory), and sociodemographic characteristics with health-related quality of life (HrQoL; measured with the EORTC Quality of Life Questionnaire QLQ-C30) were assessed in 170 recently diagnosed cancer patients. A better functional status (p<0.001) and a lower level of depressive symptoms (p<0.001) were associated with better HrQoL. In addition, an interaction effect of functional status with HrQoL was found (p<0.001), indicating that stronger functional impairments were related to lower HrQoL in patients with low and average levels of depressive symptoms, but not in those with high levels of depressive symptoms. Associations of HrQoL with sociodemographic variables were not significant. It is concluded that functional decline does not additionally impair HrQoL when patients already have elevated levels of depressive symptoms.

Adult↗
PubMed2006

Multicolor-FISH applied to resolve complex chromosomal changes in a case of T-ALL (FAB L2).

We report on a patient with a clinically diagnosed acute lymphoblastic leukemia (ALL) with partial unrecorded complex translocation events especially involving chromosomes 5, 9 and 18. At the GTG-band level the karyotype was abnormal in 20% of the analyzed cells. The complex karyotype was studied in more detail by spectral karyotyping (SKY) and multicolor banding (MCB) to characterize it in more detail. Thus, the karyotype could be described very accurately and in summary three different clones were detected, reflecting a high rate of karyotypic evolution in this patient.

Adolescent↗
PubMed2006

Chronomodulated chemotherapy with oxaliplatin, 5-FU and sodium folinate in metastatic gastrointestinal cancer patients: original analysis of non-hematological toxicity and patient characteristics in a pilot investigation.

OBJECTIVE: Several clinical trials have demonstrated that oxaliplatin is a useful agent in combination with 5-fluorouracil (5-FU) and folinic acid (FA) for the treatment of patients with colorectal carcinoma. The aims of this pilot study were to evaluate non-hematological toxicity and patient characteristics in gastrointestinal cancer patients treated with chronomodulated chemotherapy consisting of oxaliplatin, 5-FU and sodium folinate. METHODS: Patients with metastatic gastrointestinal cancer received a chronomodulated regimen with oxaliplatin (25 mg/m2), 5-FU (750 mg/m2) and sodium folinate (150 mg/m2). Non-hematological toxicities were evaluated and analyzed in relation to patient characteristics, i.e. age, sex, body weight, body mass index (BMI), body surface area and smoking status. Toxicity was graded according to the National Cancer Institute Common Toxicity Criteria. RESULTS: The severity of non-hematological toxicity was generally moderate. Grade 4 toxicity was only found in 2 patients with diarrhea (12.5%). The most frequent common adverse events were nausea, Grades 1 - 2 in 13 patients (81.3%), followed by motor neuropathy, Grades 1 - 3 in 11 patients (68.9%). The analyses showed that patient characteristics such as BMI and smoking status were associated with mucositis/stomatitis, vomiting or mood alteration. Furthermore, there was a relationship between smoking status and the overall non-hematological toxicity. Smokers had significantly higher overall toxicity than non-smokers and body mass index correlated significant with overall toxicity. CONCLUSION: The results of this pilot investigation suggest that a chronomodulated regimen with oxaliplatin, 5-FU and sodium folinate has a manageable non-hematological toxicity profile and that toxicity of the chronomodulated schedule studied depends on the patient characteristics. In further investigations, risk factors determining chemotherapeutic toxicity should be considered. Because of the small number of patients in this pilot investigation, the findings need to be confirmed in a larger clinical study.

Adult↗
PubMed2006

Pharmacokinetics of oxaliplatin and non-hematological toxicity in metastatic gastrointestinal cancer patients treated with chronomodulated oxaliplatin, 5-FU and sodium folinate in a pilot investigation.

OBJECTIVE: To analyze in a pilot study the association between the pharmacokinetics of chronomodulated administered oxaliplatin and non-hematological toxicity in patients with metastatic gastrointestinal cancer. METHODS: 16 patients received a 4-day chemotherapeutic regimen consisting of a 12-h chronomodulated infusion of oxaliplatin (25 mg/m2) followed by a 12-h chronomodulated infusion of 5-fluorouracil (750 mg/m2) and sodium folinate (150 mg/m2) daily. Plasma pharmacokinetics of oxaliplatin, measured as ultrafiltrable platinum, were determined. RESULTS: Pharmacokinetics and non-hematological adverse events could be assessed in all patients included in the study. Pharmacokinetic parameters showed moderate interpatient variability. The occurrence of nausea and vomiting, but not diarrhea, was significantly associated with the pharmacokinetics of ultrafiltrable platinum. Thus, increased AUC values were observed in patients who experienced nausea or vomiting. No differences in pharmacokinetic parameters were found between patients with and without oxaliplatin-induced neurotoxicity or the other selected non-hematological toxicities. CONCLUSION: The preliminary results in this pilot study suggest an association between pharmacokinetics of ultrafiltrable platinum and non-hematological toxicity such as nausea and vomiting. Furthermore, although the sample size is limited, systemic exposure to ultrafiltrable platinum appears to predict the risk of non-hematological toxicity in patients treated with chronomodulated oxaliplatin combined with 5-FU and FS.

Adult↗
PubMed2004

The impact of comorbidity on the survival of postmenopausal women with breast cancer.

PURPOSE: The aim was to assess the impact of comorbidity on survival of postmenopausal women with breast cancer diagnosis in the period 1995-1997. METHODS: The level of comorbidity was described by the methods suggested by Satariano and Charlson. Cox's proportional hazard models were used to explore the impact of comorbidity on all-cause mortality. RESULTS: After a median follow-up time of 52 months, an increasing level of comorbidity was associated with a higher all-cause mortality. Compared to patients with-out comorbid conditions, the hazard ration of death (HR) was 1.2 (95% CI: 0.8-1.7) for Satariano index 1 and HR 2.3 (95% CI: 1.5-3.5) for Satariano index >or=2, and HR 1.6 and 2.1 for the Charlson comorbidity index, respectively. Independent of comorbidity, the treatment pattern had a strong impact on survival. The level of comorbidity has an influence on the 3-year survival of postmenopausal women with breast cancer. CONCLUSIONS: Long-term follow-up is required to appraise these findings in relation to treatment strategies.

Aged↗
PubMed2004

Elderly patients with acute myeloid leukaemia: characteristics in biology, patients and treatment. Recommendations of the Working Group Geriatric Oncology of the German Society for Haematology and Oncology (DGHO), the Austrian Society for Haematology and Oncology (OGHO) and the German Society for Geriatrics (DGG).

While the incidence rate of acute myeloid leukaemia (AML) is increasing with the age of the patients, the 5-year-survival rates are decreasing in an age-dependent manner. Patients with AML are considered to be old when they have reached the age of 60. This consideration is due to patient- and disease-specific parameters, which reveal differences between older and younger patients with AML. Standard of therapy is a dose-intensive chemotherapy aiming at the induction of complete remission, followed by different kinds of post-remission therapies. A small percentage of patients can be cured by this approach. However, most patients will die within the first 2 years after diagnosis due to resistance or relapse of the disease or therapy-related complications. The improvements achieved in the treatment of patients with AML are mainly restricted to the group of younger patients. The small percentage of patients who are cured, and the high rate of treatment-related mortality in elderly patients with AML give rise to the question which patients benefit from a primarily curative approach, and which should be treated with a palliative approach. The value of a palliative approach has not yet been consistently assessed in clinical trials. Geriatric assessment will be an important tool in clinical trials for elderly patients with AML to be used in the decision making process. There is hope that new classes of drugs and treatment modalities such as inhibitors of signal transduction, monoclonal antibodies, inhibitors of angiogenesis, or allogenic blood stem cell therapy after non-myeloablative conditioning regimens will improve the therapy of elderly patients with AML in the near future.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2004

Chemotherapy in elderly patients with advanced lung cancer. Part I: General aspects and treatment of small cell lung cancer (SCLC).

There is much uncertainty whether chemotherapy is beneficial for elderly patients with advanced lung cancer. Whereas age alone is not an adverse prognostic factor, decline of physiological function and comorbidity can result in higher rates of treatment-related toxicity, in particular myelosuppression. The higher incidence of comorbid conditions, frequently sharing the risk profile of the malignancy, can translate into worse survival. Therefore, a geriatric assessment of the patient's overall situation should guide decision-making. Mainstay of treatment of small cell lung cancer (SCLC), also in the elderly, is combination therapy. Several retrospective analyses reveal that in elderly patients often lower drug doses are delivered. However, the treatment outcome of these patients does not appear to be worse compared to younger patients. For functionally independent elderly patients, combination chemotherapy with carboplatin and etoposide, supported by optimized supportive care, possibly including hematopoietic growth factors (G-CSF) to minimize toxicity, should be considered. Special attention to renal function should be given and individualized drug dosing, adapted to the glomerular filtration rate, is mandatory. For patients with some functional dependence or showing a certain degree of comorbidity, preliminary data indicate that single-agent therapy with carboplatin can confer the same benefit as combination chemotherapy, but with reduced toxicity. Single agent oral etoposide, however, seems to be inferior to combination treatment and should not be given routinely in the treatment of this cohort. Further evaluation of these topics is needed, and can be achieved by trials specifically designed for elderly patients or patients with reduced performance status.

Aged↗
PubMed2004

Chemotherapy in elderly patients with advanced lung cancer. Part II: Treatment of non-small cell lung cancer (NSCLC).

Increasing interest in the treatment of elderly patients or patients with poor performance status (PS) with non-small cell lung cancer (NSCLC) has led to a number of subgroup analyses of clinical trials, and even more importantly, the conduction of trials specifically designed for this cohort. These studies allow some important conclusions. Data from retrospective studies and meta-analyses indicate that the use of platinum-based two-drug combinations in selected, fit elderly patients may produce response rates, survival, and toxicity comparable to those in younger patients. This excludes a per se inferior effectiveness of chemotherapy in the population of elderly patients with NSCLC. A number of more recently introduced agents with a favourable toxicity profile have significantly increased treatment options. Single- agent therapy with vinorelbine, when compared to best supportive care, has been shown to give a statistically significant survival benefit and improve quality of life. Conflicting data from phase II/III trials in elderly patients with NSCLC exist regarding a potential benefit of combination chemotherapy over single-agent treatment in the total cohort of elderly patients, including those with comorbidities or declining functional reserve. A review of the most important trials, assessing treatment options in elderly patients with lung cancer, either prospectively or retrospectively, is provided, and still unresolved issues are addressed.

Aged↗
PubMed2003

A population-based study on variations in the use of adjuvant systemic therapy on postmenopausal patients with early stage breast cancer.

PURPOSE: To assess adherence to treatment recommendations regarding adjuvant systemic therapy of postmenopausal patients with early stage breast cancer. METHODS: A population-based cohort of women from Eastern Thuringia/Germany with first diagnosis of breast cancer in 1995-2000 was studied. The use of adjuvant therapy was assessed separately for patients with positive and negative nodal status fitting polytomous logistic regression models. RESULTS: Among 396 women with positive lymph nodes and 832 with negative lymph nodes, 92.9% and 87.3% received an adjuvant systemic treatment, respectively. Age, comorbidity, hormone receptor status, histological grading, and additionally, in nodal positives, the number of involved lymph nodes, were associated with treatment patterns. Age had the strongest impact on treatment decision. Older women more often received hormone- or no adjuvant therapy. However, 26.3% of the women with lymph node involvement and positive hormone receptor status received no hormone therapy, whereas 35.7% of women with negative hormone receptor status received hormone therapy. CONCLUSION: The number of patients with adjuvant systemic therapy is high in women with positive and those with negative lymph nodes, reflecting adherence to the recommendations. Better outcome could be expected if hormone therapy was used adequately in receptor positives. Further follow-up is required to monitor the outcome and changes in adherence to treatment recommendations.

Aged↗
PubMed2003

[Oncologic pharmacotherapy of elderly patients].

Age is the major risk factor for the development of cancer. Difficulties in medical treatment of elderly patients with cancer may be due to age dependent changes in physiological organ function, which result in pharmacokinetical and pharmacodynamical changes. They also may be due to co-morbidities with the need of pharmacological therapy. The choice of adequate treatment protocols has to consider this age dependent changes in pharmacokinetics and the presence of co-morbidities. Most of the data reporting results of medical oncological treatment in patients with cancer are collected in younger patients. Therefore, the present knowledge concerning medical oncological treatment of elderly patients with cancer is still limited.

Aged↗
PubMed2003

Comprehensive geriatric assessment in the elderly cancer patient.

The proportion of older cancer patients is increasing due to demographic and disease-specific reasons. However, this group of patients is severely underrepresented in research and clinical therapy. Limitation in physical and functional capacity with considerable interindividual heterogeneity remains one of the important problems in the treatment decision process. One approach to this problem is the use of a Comprehensive Geriatric Assessment (CGA) to describe and classify these deficits with high validity and reliability. The different domains of CGA are described with special respect to the instruments applied, as CGA has also a key role in the decision process.

Activities of Daily Living↗
PubMed2002

[Therapy of elderly patients with leukemias and malignant lymphomas].

Incidence of most malignant lymphomas and leukaemias is increasing with advanced age. 5-year-survival-rates are worse in elderly patients. Therapeutic decisions have to consider possible changes in the biology of the disease together with the age dependent increase in the prevalence of comorbid conditions and the limitations of functional status. Dose intensive chemotherapy protocols, as they are necessary for therapy of acute leukaemias and aggressive malignant lymphomas, are associated with an increased rate of therapy related morbidity and mortality in elderly patients. Supportive care is an essential part of the therapy. Treatment strategies for elderly patients are reviewed within this article.

Age Factors↗
PubMed2002

[Introduction to geriatric oncology].

The demographic changes will result in a profound increase of the number of elderly people within the next years. As a consequence of the age dependent increase of the incidence and mortality rate of cancer these changes will bring an increase in the number of elderly people with cancer. There is a number of differences between young and old patients diagnosed with cancer. This must result in an adaption of standardised oncological procedures, mainly designed for younger patients, to the special situation of elderly patients. The differences between young and old patients with cancer may be depicted by a structured geriatric assessment. Suggestions for the structure of such an assessment exist. Ongoing clinical trials have to demonstrate, whether or not the inclusion of a geriatric oncological assessment in the decision making process will result in an improvement of treatment results in elderly cancer patients diagnosed with cancer.

Aged↗
PubMed2002

Use of hematopoietic growth factors in elderly patients receiving cytotoxic chemotherapy.

Myelosuppression is a common side effect in elderly patients undergoing chemotherapy. Neutropenia and anemia cause considerable morbidity, may increase mortality, and can result in a worse outcome of treatment in elderly patients compared to younger patients with comparable type and stage of disease. The availability and proven efficacy of hematopoietic growth factors such as granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF) and erythropoietin (EPO) have had a considerable impact on supportive care in cancer patients: Several randomized trials have demonstrated a reduction of neutropenia and the frequency of severe infections in elderly patients treated with G-CSF following myelotoxic chemotherapy compared with patients without growth factor support. Both for G-CSF and for recombinant human erythropoietin (rHu-EPO) several studies have demonstrated the safety and effectiveness of these molecules in elderly patients with regard to increasing hemoglobin concentrations, improving quality of life (rHu-EPO), and neutrophil recovery. Although a positive effect of the use of growth factors on overall survival in elderly cancer patients is not yet proven, a reduction of chemotherapy-induced side effects could clearly be shown. The National Comprehensive Cancer Network (NCCN) of cancer centers has recommended that all patients aged 70 years and older treated with CHOP or cytotoxic chemotherapy of comparable intensity should receive prophylactic G-CSF administration, and that the hemoglobin concentration be maintained at >or=12 g/dl in elderly patients undergoing chemotherapy.

Aged↗
PubMed2001

[Therapy of acute myeloid leukemia in the elderly patient].

Incidence and mortality rates of acute myeloid leukemia (AML) increase exponentially with advancing age. AML diagnosed in elderly patients differs from that diagnosed in younger patients. But not only disease-specific differences are important. Treating elderly patients with AML age-associated differences in the patients general presentation, such as physiological changes in organ function, decreased ability to react to stress, dependence in activities of daily living, existence of other morbidities (co-morbidity), the need to take drugs for those diseases and the reduced life expectancy can force alterations in the disease management. Clinical trials for the treatment of AML have been excluding elderly patients for years. Even trials accepting elderly patients with AML did select the group of otherwise healthy elderly patients for participation in the trial. Thus the data for AML management in elderly patients do not reflect the whole group of elderly patients with AML. If the patient is treated with curative intention, therapy of choice is the so-called 3 + 7 protocol for induction of complete remission, followed by a consolidation therapy and in some cases by maintenance therapy. In some situations, especially in very old patients, a palliative intention to treatment is favored. There are no generally accepted criteria to measure treatment benefit in this setting nor established chemotherapy protocols for this situation. Further trials for elderly patients with AML have to offer treatment options for the whole group of patients and have to determine what treatment approach is the best for which individual patient.

Adolescent↗
PubMed2001

[Chemotherapy of colorectal cancer--which therapy is justified for elderly patients?].

Treating elderly patients with colorectal cancer is a challenging task for which many aspects have to be taken into account. 70% of patients with colorectal cancer are 65 years or older and the number of elderly patients is expected to increase. As elderly patients frequently exhibit adverse physical or socio-economic conditions, a thorough geriatric assessment of the patient's suitability for therapy is essential before making a decision. At present, adjuvant 5-FU based chemotherapy (in colon cancer) and adjuvant radio-chemotherapy (in rectal cancer) in the elderly is recommended for locally advanced or node positive tumor after tumor resection, since the benefit may be comparable to that achieved in younger patients. There is enough data to support the use of 5-FU based chemotherapy in elderly patients in the palliative setting. New substances have recently been added to the armentarium for metastatic colorectal cancer. However, there is as yet not sufficient data to guide the use of these new drugs (such as oxaliplatin or irinotecan) in elderly patients. However, first clinical studies seem to indicate a comparable efficacy and toxicity in elderly patients to that observed in younger patients. Further clinical trials of chemotherapy in elderly patients with colorectal cancer are necessary to gain information about treatment recommendations.

Aged↗
PubMed2001

[Treatment of multiple myeloma in elderly patients: consensus of the Geriatric Oncology Working Group of the German Society of Hematologic Oncology and the German Society of Geriatrics].

Treatment of Multiple Myeloma in the Elderly: Consensus of the Cooperative Group of Geriatric Oncology of the DGHO and DGG Multiple myeloma is an illness of old age. Often, in elderly people the diagnosis is delayed by the fact that bone pain, which is the most frequently presenting symptom, is not correctly interpreted because this is a common complaint in the elderly. In contrast to younger patients with multiple myeloma, elderly patients often present with infections at diagnosis. After the diagnosis is established, careful observation is very important. This applies both to patients who require still no therapy and to patients under treatment. In order to optimize the care of older patients, apart from tumor-specific investigations multidimensional geriatric assessment is helpful. This specifically applies for multiple myeloma which predisposes the patient to 'instability' and 'immobility', both belonging to the typical geriatric symptoms. Geriatric assessment may also be helpful in the selection of those elderly patients who are candidates for a possible prognosis-improving experimental intense chemotherapy. For the majority of the elderly patients in need of treatment the standard is melphalan/prednisone accompanied by one of the biphosphonates. Nevertheless, in order to improve prospects also for this group of patients, as many elderly patients as possible should be included into studies. This is the only way to compile valid recommendations for the treatment of elderly patients with multiple myeloma.

Aged↗