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Symptomlinderung durch Tumortherapie?

Eine systematische Übersicht über onkologische Therapiestudien

Anticancer therapy for symptom relief?

A systematic review of clinical trials in oncology

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Zusammenfassung

Hintergrund

Bei inkurabel erkrankten Krebspatienten wird die medikamentöse Tumortherapie zumeist mit dem Ziel einer längeren Überlebenszeit bei zugleich möglichst geringer Toxizität und tolerabler Lebensqualität unter der Therapie eingesetzt. Unklar ist, inwieweit und mit welchem Erfolg die medikamentöse Tumortherapie zu einer gezielten Verbesserung von vorbestehenden Schmerzen und einer bereits kompromittierten Lebensqualität eingesetzt werden kann.

Methodik

Daher wurde ein „systematic review“ onkologischer Therapiestudien (PubMed) durchgeführt. Es wurden ausschließlich Studien ausgewählt und deskriptiv ausgewertet, die schmerzlindernde bzw. lebensqualitätsverbessernde Effekte einer medikamentösen Tumortherapie als primären Studienendpunkt auswiesen.

Ergebnisse

Von den 2229 mithilfe eines pilotierten Such-Strings identifizierten Abstracts erfüllten nach Durchsicht lediglich 13 Studien die Einschlusskriterien. Von diesen zeigten 10 Studien eine Verbesserung von Lebensqualitätsparametern durch den Einsatz systemischer Tumortherapien.

Diskussion

Nur wenige Studien fokussierten primär auf die Verbesserung lebensqualitätsbezogener Parameter – obwohl dies für nicht wenige inkurabel und fortgeschritten erkrankte Krebspatienten das vorrangige Therapieziel darstellt. Die Studienergebnisse ermutigen dazu, symptom- und lebensqualitätsbezogene Daten regelmäßig in klinischen Studien zu berücksichtigen und das Potenzial der onkologischen Tumortherapie für palliativmedizinisch relevante Zielsetzungen der Schmerz- und Symptomlinderung expliziter zu adressieren.

Abstract

Background

When patients suffer from incurable cancer, drug-based, systemic anticancer therapy is usually used with the aim of longer survival, while minimizing toxicity and ensuring a tolerable quality of life. It is unclear to what extent and with what degree of success systemic tumor therapy can be used to specifically improve pre-existing pain and an already compromised quality of life (QoL).

Methods

Therefore, a systematic review of oncological therapy studies (PubMed) was conducted. Only studies that identified the pain-relieving and QoL-enhancing effects of systemic anticancer therapy as the primary endpoint were selected and evaluated descriptively.

Results

Of the 2229 abstracts identified using a piloted search string, only 13 studies met the inclusion criteria. Of these, 10 studies showed an improvement in QoL-parameters through the use of systemic tumor therapies.

Discussion

Only a few studies focused primarily on the improvement of parameters related to quality of life—although this is the primary therapeutic goal for many patients suffering from incurable and advanced cancer. The study results encourage regular inclusion of symptom- and QoL-related data in clinical studies and to more explicitly address the potential of systemic anticancer therapy in relieving pain and other symptoms, thereby supporting the goals of palliative care.

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Danksagung

Das methodische Konzept dieser Übersichtsarbeit wurde in enger Zusammenarbeit mit dem Institut für Medizinische Statistik der Universität Göttingen (Prof. Dr. T. Friede, PD Dr. S. Straube) erstellt – für diese Unterstützung möchten die Autoren herzlich danken.

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  1. Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland

    B. Alt-Epping, M. Jansky & F. Nauck

  2. Medizinische Fakultät, Universitätsmedizin Göttingen, Göttingen, Deutschland

    A.-L. Haas

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Correspondence to B. Alt-Epping.

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B. Alt-Epping, A.-L. Haas, M. Jansky und F. Nauck geben an, dass kein Interessenkonflikt besteht.

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Alt-Epping, B., Haas, AL., Jansky, M. et al. Symptomlinderung durch Tumortherapie?. Schmerz 32, 90–98 (2018). https://doi.org/10.1007/s00482-018-0270-1

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