Der Onkologe

, Volume 14, Issue 7, pp 691–700 | Cite as

Übertherapie in der Onkologie: Wann ist weniger mehr?

Leitthema

Zusammenfassung

Es liegen nur wenige systematische Daten vor, die untersuchen, inwieweit in der Versorgung onkologischer Patienten in Deutschland eine Überbehandlung stattfindet. Überbehandlung wird in der Onkologie bewusst im Bereich der adjuvanten Therapie in Kauf genommen. Der Behandlungsvorteil einiger Patienten rechtfertigt hier die Therapie vieler Patienten. Aufgabe zukünftiger Studien ist es, diejenigen Patienten besser zu identifizieren, die von einer Therapie profitieren. Im Bereich der Behandlung mit nichtkurativem Ziel werden in Dritt-, Viert- oder Fünftlinien-Chemotherapien häufig wissenschaftlich nicht begründete Hoffnungen gelegt. Eine autonome Entscheidung seitens des Patienten setzt hier die Kenntnis palliativmedizinischer Behandlungsmöglichkeiten voraus.

Schlüsselwörter

Überbehandlung Onkologie Adjuvante Therapie Palliative Therapie Supportive Therapie 

Overtreatment in oncology: when does less become more?

Abstract

Only few systematically collected data are available analyzing overtreatment in oncological patients in Germany. Overtreatment is knowingly accepted in the adjuvant treatment setting. The treatment benefit of some patients justifies the treatment of many patients. It is the task for future trials to improve the selection of those patients with the most likelihood of benefit. In the non-curative treatment approach, scientifically unfounded hopes are often pinned on third-, fourth-, or fifth-line chemotherapies. An informed consent implies that the patient has knowledge of the treatment options for palliative care.

Keywords

Overtreatment Oncology Adjuvant treatment Palliative treatment Supportive care 

Notes

Interessenkonflikt

Keine Angaben.

Literatur

  1. 1.
    (1998) Transferability to clinical practice of the results of controlled clinical trials: the case of antiemetic prophylactic treatment for cancer chemotherapy-induced nausea and vomiting. Italian Group for Antiemetic Research. Ann Oncol 9: 759–765Google Scholar
  2. 2.
    Early Breast Cancer Trialists‘ Collaborative Group (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365: 1687–1717CrossRefGoogle Scholar
  3. 3.
    Aapro MS, Cameron DA, Pettengell R et al. (2006) EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumours. Eur J Cancer 42: 2433–2453PubMedCrossRefGoogle Scholar
  4. 4.
    Appelbaum FR, Gundacker H et al. (2006) Age and acute myeloid leukemia. Blood 107: 3481–3485PubMedCrossRefGoogle Scholar
  5. 5.
    Bacher U, Haferlach C et al. (2008) Prognostic relevance of FLT3-TKD mutations in AML: the combination matters – an analysis of 3082 patients. Blood 111: 2527–2537PubMedCrossRefGoogle Scholar
  6. 6.
    Bauer AW (2003) Futility-Debatte in der Onkologie. Onkologe 9: 1325–1334CrossRefGoogle Scholar
  7. 7.
    Bennett CL, Silver SM et al. (2008) Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA 299: 914–924PubMedCrossRefGoogle Scholar
  8. 8.
    Brust-Zentrum W (2007) Jahresauswertung Benchmarking Brustzentren WBC. W. W. B.-Z. GmbHGoogle Scholar
  9. 9.
    Chapman JA, Meng D et al. (2008) Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer. J Natl Cancer Inst 100: 252–260PubMedCrossRefGoogle Scholar
  10. 10.
    Elkin EB, Hurria A et al. (2006) Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: assessing outcome in a population-based, observational cohort. J Clin Oncol 24: 2757–2764PubMedCrossRefGoogle Scholar
  11. 11.
    Engel J, Nagel G et al. (2002) Primary breast cancer therapy in six regions of Germany. Eur J Cancer 38: 578–585PubMedCrossRefGoogle Scholar
  12. 12.
    Etienne A, Esterni B et al. (2007) Comorbidity is an independent predictor of complete remission in elderly patients receiving induction chemotherapy for acute myeloid leukemia. Cancer 109: 1376–1383PubMedCrossRefGoogle Scholar
  13. 13.
    Extermann M, Aapro M et al. (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 55: 241–252PubMedCrossRefGoogle Scholar
  14. 14.
    Falini B, Mecucci C et al. (2005) Cytoplasmic nucleophosmin in acute myelogenous leukemia with a normal karyotype. N Engl J Med 352: 254–266PubMedCrossRefGoogle Scholar
  15. 15.
    Friedrich C, Kolb G et al. (2003) Comprehensive geriatric assessment in the elderly cancer patient. Onkologie 26: 355–360PubMedCrossRefGoogle Scholar
  16. 16.
    Giordano SH, Duan Z et al. (2006) Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol 24: 2750–2756PubMedCrossRefGoogle Scholar
  17. 17.
    Giordano SH, Hortobagyi GN (2008) Time to remove the subspecialty blinders: breast cancer does not exist in isolation. J Natl Cancer Inst 100: 230–231PubMedCrossRefGoogle Scholar
  18. 18.
    Grimwade D, Walker H et al. (2001) The predictive value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia (AML): analysis of 1065 patients entered into the United Kingdom Medical Research Council AML11 trial. Blood 98: 1312–1320PubMedCrossRefGoogle Scholar
  19. 19.
    Grothey A, Kellermann L et al. (2002) Deficits in management of patients with colorectal carcinoma in Germany. Results of multicenter documentation of therapy algorithms. Med Klin 97: 270–277CrossRefGoogle Scholar
  20. 20.
    Jessup JM, Stewart A et al. (2005) Adjuvant chemotherapy for stage III colon cancer: implications of race/ethnicity, age, and differentiation. JAMA 294: 2703–2711PubMedCrossRefGoogle Scholar
  21. 21.
    Kuderer NM, Dale DC et al. (2006) Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 106: 2258–2266PubMedCrossRefGoogle Scholar
  22. 22.
    Leith CP, Kopecky KJ et al. (1997) Acute myeloid leukemia in the elderly: assessment of multidrug resistance (MDR1) and cytogenetics distinguishes biologic subgroups with remarkably distinct responses to standard chemotherapy. A Southwest Oncology Group study. Blood 89: 3323–3329PubMedGoogle Scholar
  23. 23.
    Lowenberg B, Zittoun R et al. (1989) On the value of intensive remission-induction chemotherapy in elderly patients of 65+ years with acute myeloid leukemia: a randomized phase III study of the European Organization for Research and Treatment of Cancer Leukemia Group. J Clin Oncol 7: 1268–1274PubMedGoogle Scholar
  24. 24.
    Lyman GH (1998) Essentials of clinical decision making: a new way to think about cancer and aging. In: Balducci L, Lyman GH, Ershler W (eds) Comprehensive geriatric oncology. Harwood, AmsterdamGoogle Scholar
  25. 25.
    Morris M, Platell C et al. (2007) Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients. Br J Cancer 96: 701–707PubMedCrossRefGoogle Scholar
  26. 26.
    Muss HB, Biganzoli L et al. (2007) Adjuvant therapy in the elderly: making the right decision. J Clin Oncol 25: 1870–1875PubMedCrossRefGoogle Scholar
  27. 27.
    Nagel G, Wedding U et al. (2004) The impact of comorbidity on the survival of postmenopausal women with breast cancer. J Cancer Res Clin Oncol 130: 664–670PubMedCrossRefGoogle Scholar
  28. 28.
    Pinquart M, Hoffken K et al. (2007) Social support and survival in patients with acute myeloid leukaemia. Support Care Cancer 15: 81–87PubMedCrossRefGoogle Scholar
  29. 29.
    Saarni SI, Halila R et al. (2008) Ethically problematic treatment decisions in different medical specialties. J Med Ethics 34: 262–267PubMedCrossRefGoogle Scholar
  30. 30.
    Sargent DJ, Patiyil S et al. (2007) End points for colon cancer adjuvant trials: observations and recommendations based on individual patient data from 20,898 patients enrolled onto 18 randomized trials from the ACCENT Group. J Clin Oncol 25: 4569–4574PubMedCrossRefGoogle Scholar
  31. 31.
    Schairer C, Mink PJ et al. (2004) Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst 96: 1311–1321PubMedCrossRefGoogle Scholar
  32. 32.
    Scholl S, Theuer C et al. (2008) Clinical impact of nucleophosmin mutations and Flt3 internal tandem duplications in patients older than 60 yr with acute myeloid leukaemia. Eur J Haematol 80: 208–215PubMedCrossRefGoogle Scholar
  33. 33.
    Schwartz LM, Woloshin S et al. (1999) Risk communication in clinical practice: putting cancer in context. J Natl Cancer Inst Monogr 25: 124–133PubMedGoogle Scholar
  34. 34.
    Silvestri G, Pritchard R et al. (1998) Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews. BMJ 317: 771–775PubMedGoogle Scholar
  35. 35.
    Slevin ML, Stubbs L et al. (1990) Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ 300: 1458–1460PubMedCrossRefGoogle Scholar
  36. 36.
    Smith TJ, Khatcheressian J et al. (2006) 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 24: 3187–3205PubMedCrossRefGoogle Scholar
  37. 37.
    Tilly H, Castaigne S et al. (1990) Low-dose cytarabine versus intensive chemotherapy in the treatment of acute nonlymphocytic leukemia in the elderly. J Clin Oncol 8: 272–279PubMedGoogle Scholar
  38. 38.
    Wedding U, Rohrig B et al. (2006) Impairment in functional status and survival in patients with acute myeloid leukaemia. J Cancer Res Clin Oncol 132: 665–671PubMedCrossRefGoogle Scholar
  39. 39.
    Welch HG, Albertsen PC et al. (1996) Estimating treatment benefits for the elderly: the effect of competing risks. Ann Intern Med 124: 577–584PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Klinik für GeriatrieUniversitätsklinikum JenaJenaDeutschland
  2. 2.Abteilung für Innere MedizinKrankenhaus Barmherzige Brüder WienWienÖsterreich
  3. 3.Klinik und Poliklinik für Innere Medizin II, Abteilung Hämatologie und OnkologieUniversitätsklinikum JenaJenaDeutschland

Personalised recommendations