Benjamin Barnes

Prevalence of anticipatory nausea and other side-effects in cancer patients receiving chemotherapy

98 patients receiving chemotherapy for cancer were interviewed to determine the prevalence of anticipatory nausea and vomiting, anxiety and dietary changes. Among those who had received at least four treatments 41% reported at least mild anticipatory nausea (AN). For 24% this was a moderate to severe problem, which was significantly associated with a high level of anxiety about treatment. Prevalence at this level was independent of whether the subject was receiving treatment as an in- or an outpatient. Anticipatory vomiting (AV) was reported by only 12 patients, of whom 11 were women; this was the only effect of gender found in the sample. Independence between moderate AN and AV was also suggested by a difference in type of event triggering the effect: predominantly odours for AN and thoughts of the treatment for AV. Changes in diet after commencing chemotherapy were reported by 50% of patients who had received at least four treatments. These most commonly took the form of aversions to meat and then to coffee, and were attributed most frequently to changes in taste and then to loss of appetite.

Recent cancer survival in Germany: an analysis of common and less common cancers.

The monitoring of cancer survival by population‐based cancer registries is a prerequisite to evaluate the current quality of cancer care. Our study provides 1‐, 5‐ and 10‐year relative survival as well as 5‐year relative survival conditional on 1‐year survival estimates and recent survival trends for Germany using data from 11 population‐based cancer registries, covering around one‐third of the German population. Period analysis was used to estimate relative survival for 24 common and 11 less common cancer sites for the period 2007–2010. The German and the United States survival estimates were compared using the Surveillance, Epidemiology and End Results 13 database. Trends in cancer survival in Germany between 2002–2004 and 2008–2010 were described. Five‐year relative survival increased in Germany from 2002–2004 to 2008–2010 for most cancer sites. Among the 24 most common cancers, largest improvements were seen for multiple myeloma (8.0% units), non‐Hodgkin lymphoma (6.2% units), prostate cancer (5.2% units) and colorectal cancer (4.6% units). In 2007–2010, the survival disadvantage in Germany compared to the United States was largest for cancers of the mouth/pharynx (−11.0% units), thyroid (−6.8% units) and prostate (−7.5% units). Although survival estimates were much lower for elderly patients in both countries, differences in age patterns were observed for some cancer sites. The reported improvements in cancer survival might reflect advances in the quality of cancer care on the population level as well as increased use of screening in Germany. The survival differences across countries and the survival disadvantage in the elderly require further investigation.

Survival of adults with acute lymphoblastic leukemia in Germany and the United States.

Background Adulthood acute lymphoblastic leukemia (ALL) is a rare disease. In contrast to childhood ALL, survival for adults with ALL is poor. Recently, new protocols, including use of pediatric protocols in young adults, have improved survival in clinical trials. Here, we examine population level survival in Germany and the United States (US) to gain insight into the extent to which changes in clinical trials have translated into better survival on the population level. Methods Data were extracted from the Surveillance, Epidemiology, and End Results database in the US and 11 cancer registries in Germany. Patients age 15–69 diagnosed with ALL were included. Period analysis was used to estimate 5-year relative survival (RS). Results Overall 5-year RS was estimated at 43.4% for Germany and 35.5% for the US (p = 0.004), with a decrease in survival with increasing age. Survival was higher in Germany than the US for men (43.6% versus 37.7%, p = 0.002) but not for women (42.4% versus 40.3%, p>0.1). Five-year RS estimates increased in Germany and the US between 2002 and 2006 by 11.8 and 7.3 percent units, respectively (p = 0.02 and 0.04, respectively). Conclusions Survival for adults with ALL continues to be low compared with that for children, but a substantial increase in 5-year survival estimates was seen from 2002 to 2006 in both Germany and the US. The reasons for the survival differences between both countries require clarification.

Changes in cancer incidence attributable to tobacco smoking in Germany, 1999-2008.

Tobacco smoking, a major cancer risk factor, is very common in Germany as in many other high‐income countries. Few studies have assessed the burden of tobacco‐associated cancer incidence in the German population. We calculated the proportion of cancers attributable to tobacco smoking to estimate the burden of tobacco‐associated cancer in 1999 and 2008. Smoking prevalence was determined from national surveys of a representative sample of the German population in 1998 and 2008–2011, and data on relative risks were obtained from meta‐analyses. Cancer incidence for the years 1999 and 2008 was estimated by the German Centre for Cancer Registry Data at the Robert Koch Institute. We estimate that 72,208 incident cancer cases were attributable to tobacco smoking in Germany in 2008, an increase of >6,200 cases over 1999 levels. Among the cases in 2008 were 55,057 cases among men (22.8% (95% CI, 21.3–24.1) of all new cases) and 17,151 cases among women (7.9% (95% CI, 7.21–8.68) of all new cases). The highest proportions attributable to smoking were estimated for cancer of the lung, larynx, pharynx and the lower urinary tract. Tobacco smoking is currently responsible for more than one in five cancer cases among men and nearly 1 in 12 among women. Considering the increasing trends in cancer incidence and, until very recently, rising prevalence of smoking among women, it can be expected that the number of tobacco‐attributable cancer cases will rise further.

Von regionalen Daten zu bundesweiten Aussagen

Despite having achieved nationwide registry coverage in addition to substantial improvements in data on the epidemiology of cancer in Germany, the Centre for Cancer Registry Data continues to estimate national statistics on incidence, survival, and prevalence instead of calculating these directly from available data. The methods used for evaluations are based initially on estimates of registration completeness or, for survival analyses, an assessment of the quality of follow-up data. The completeness of incident case registration is estimated on the basis of the mortality/incidence procedure, which assumes a largely constant relationship between the mortality and incidence of a cancer type among people of the same age and sex across federal states. Inclusion criteria for consideration of registry data in national survival analyses are less than 15% of death certificate only (DCO) cases and plausible survival for patients with pancreatic cancer or metastatic lung cancer. Of the 477,300 incident cancer cases estimated for 2010, 429,900 were reported by the cancer registries (90%), and ten federal states contributed data to national survival estimates.

Survival in patients with acute myeloblastic leukemia in Germany and the United States: Major differences in survival in young adults

Previous epidemiologic studies on AML have been limited by the rarity of the disease. Here, we present population level data on survival of patients with AML in Germany and the United States (US). Data were extracted from 11 population‐based cancer registries in Germany and the Surveillance, Epidemiology, and End Results (SEER13) database in the US. Patients diagnosed with AML in 1997–2011 were included. Period analysis was used to estimate 5‐year relative survival (RS) and trends in survival in the early 21st century. Overall 5‐year age‐adjusted RS for patients with AML in 2007–2011 was greater in Germany than in the US at 22.8% and 18.8%, respectively. Five‐year RS was higher in Germany than in the US at all ages, with particularly large differences at ages 15–24 for whom 5‐year RS was 64.3% in Germany and 55.0% in the US and 35–44, with 5‐year RS estimates of 61.8% in Germany and 46.6% in the US. Most of the difference in 5‐year RS was due to higher 1‐year RS, with overall 1‐year RS estimates of 47.0% in Germany and 38.5% in the US. A small increase in RS was observed between 2003–2005 and 2009–2011 in both countries, but no increase in survival was observed in either country for ages 75+. To our knowledge, this is the first detailed description of AML survival in Germany. Comparison to the US suggests that further analysis into risk factors for poor outcomes in AML in the US may be useful in improving survival.

Das Zentrum für Krebsregisterdaten (ZfKD) im Robert Koch-Institut (RKI) in Berlin

Cancer represents the second most common cause of death in Germany. The countrys federal states operate regional population-based cancer registries that collect and analyze data on cancer patients. This provides an essential basis for describing the cancer burden in the German population. In order to obtain valid and reliable information on cancer incidence at the national level, the Robert Koch Institute (RKI) set up the Federal Cancer Surveillance Unit in 1983 as a central institution for evaluating this cancer registry data. In August 2009, when the Federal Cancer Registry Data Act (BKRG) came into force, the Center for Cancer Registry Data (ZfKD) at the RKI took over the work of the Cancer Surveillance Unit with a broader remit. In the future, it will also regularly publish findings on survival, prevalence, and tumor stage distribution. A newly established record linkage process will help identify multiple submissions from the federal states. Further innovations and new tasks of the ZfKD include expanding an interactive Internet platform and encouraging a more intensive use of cancer registry data for epidemiological research by providing datasets to external scientists. The range of information available to the interested public is also to be expanded.ZusammenfassungKrebserkrankungen stellen in Deutschland die zweithäufigste Todesursache dar. Zur Beschreibung der Krebsbelastung in der deutschen Bevölkerung ist die Erhebung und Auswertung von Daten über Auftreten und Häufigkeiten von Krebserkrankungen durch die epidemiologischen Krebsregister der Länder wesentliche Grundlage. Um valide Aussagen zur Krebshäufigkeit auf Bundesebene zu erhalten, wurde 1983 im Robert Koch-Institut (RKI) die „Dachdokumentation Krebs“ als zentrale Auswertungsstelle für die Daten dieser Krebsregister eingerichtet. Nach Inkrafttreten des Bundeskrebsregisterdatengesetzes (BKRG) im August 2009 setzt das „Zentrum für Krebsregisterdaten“ (ZfKD) am RKI die Arbeit der „Dachdokumentation Krebs“ mit erweitertem Aufgabenspektrum fort. Künftig werden auch regelmäßig Ergebnisse zu Überlebensraten, Prävalenzen und Verteilung der Tumorstadien veröffentlicht. Neu etabliert wird ein länderübergreifender Datenabgleich zur Identifizierung von Mehrfachübermittlungen. Weitere Aufgaben des ZfKD sind der Ausbau einer interaktiven Internetplattform und die Bereitstellung von Datensätzen für externe Wissenschaftler, um die Nutzung der Krebsregisterdaten für die epidemiologische Forschung zu fördern. Auch soll das Informationsangebot für die interessierte Öffentlichkeit erweitert werden.AbstractCancer represents the second most common cause of death in Germany. The country’s federal states operate regional population-based cancer registries that collect and analyze data on cancer patients. This provides an essential basis for describing the cancer burden in the German population. In order to obtain valid and reliable information on cancer incidence at the national level, the Robert Koch Institute (RKI) set up the Federal Cancer Surveillance Unit in 1983 as a central institution for evaluating this cancer registry data. In August 2009, when the Federal Cancer Registry Data Act (BKRG) came into force, the Center for Cancer Registry Data (ZfKD) at the RKI took over the work of the Cancer Surveillance Unit with a broader remit. In the future, it will also regularly publish findings on survival, prevalence, and tumor stage distribution. A newly established record linkage process will help identify multiple submissions from the federal states. Further innovations and new tasks of the ZfKD include expanding an interactive Internet platform and encouraging a more intensive use of cancer registry data for epidemiological research by providing datasets to external scientists. The range of information available to the interested public is also to be expanded.

The (German) Center for Cancer Registry Data (ZfKD) at the Robert Koch Institute (RKI) in Berlin

Cancer represents the second most common cause of death in Germany. The countrys federal states operate regional population-based cancer registries that collect and analyze data on cancer patients. This provides an essential basis for describing the cancer burden in the German population. In order to obtain valid and reliable information on cancer incidence at the national level, the Robert Koch Institute (RKI) set up the Federal Cancer Surveillance Unit in 1983 as a central institution for evaluating this cancer registry data. In August 2009, when the Federal Cancer Registry Data Act (BKRG) came into force, the Center for Cancer Registry Data (ZfKD) at the RKI took over the work of the Cancer Surveillance Unit with a broader remit. In the future, it will also regularly publish findings on survival, prevalence, and tumor stage distribution. A newly established record linkage process will help identify multiple submissions from the federal states. Further innovations and new tasks of the ZfKD include expanding an interactive Internet platform and encouraging a more intensive use of cancer registry data for epidemiological research by providing datasets to external scientists. The range of information available to the interested public is also to be expanded.ZusammenfassungKrebserkrankungen stellen in Deutschland die zweithäufigste Todesursache dar. Zur Beschreibung der Krebsbelastung in der deutschen Bevölkerung ist die Erhebung und Auswertung von Daten über Auftreten und Häufigkeiten von Krebserkrankungen durch die epidemiologischen Krebsregister der Länder wesentliche Grundlage. Um valide Aussagen zur Krebshäufigkeit auf Bundesebene zu erhalten, wurde 1983 im Robert Koch-Institut (RKI) die „Dachdokumentation Krebs“ als zentrale Auswertungsstelle für die Daten dieser Krebsregister eingerichtet. Nach Inkrafttreten des Bundeskrebsregisterdatengesetzes (BKRG) im August 2009 setzt das „Zentrum für Krebsregisterdaten“ (ZfKD) am RKI die Arbeit der „Dachdokumentation Krebs“ mit erweitertem Aufgabenspektrum fort. Künftig werden auch regelmäßig Ergebnisse zu Überlebensraten, Prävalenzen und Verteilung der Tumorstadien veröffentlicht. Neu etabliert wird ein länderübergreifender Datenabgleich zur Identifizierung von Mehrfachübermittlungen. Weitere Aufgaben des ZfKD sind der Ausbau einer interaktiven Internetplattform und die Bereitstellung von Datensätzen für externe Wissenschaftler, um die Nutzung der Krebsregisterdaten für die epidemiologische Forschung zu fördern. Auch soll das Informationsangebot für die interessierte Öffentlichkeit erweitert werden.AbstractCancer represents the second most common cause of death in Germany. The country’s federal states operate regional population-based cancer registries that collect and analyze data on cancer patients. This provides an essential basis for describing the cancer burden in the German population. In order to obtain valid and reliable information on cancer incidence at the national level, the Robert Koch Institute (RKI) set up the Federal Cancer Surveillance Unit in 1983 as a central institution for evaluating this cancer registry data. In August 2009, when the Federal Cancer Registry Data Act (BKRG) came into force, the Center for Cancer Registry Data (ZfKD) at the RKI took over the work of the Cancer Surveillance Unit with a broader remit. In the future, it will also regularly publish findings on survival, prevalence, and tumor stage distribution. A newly established record linkage process will help identify multiple submissions from the federal states. Further innovations and new tasks of the ZfKD include expanding an interactive Internet platform and encouraging a more intensive use of cancer registry data for epidemiological research by providing datasets to external scientists. The range of information available to the interested public is also to be expanded.

[Nationwide statements from regional data: methods of the Center for Cancer Registry Data].

Despite having achieved nationwide registry coverage in addition to substantial improvements in data on the epidemiology of cancer in Germany, the Centre for Cancer Registry Data continues to estimate national statistics on incidence, survival, and prevalence instead of calculating these directly from available data. The methods used for evaluations are based initially on estimates of registration completeness or, for survival analyses, an assessment of the quality of follow-up data. The completeness of incident case registration is estimated on the basis of the mortality/incidence procedure, which assumes a largely constant relationship between the mortality and incidence of a cancer type among people of the same age and sex across federal states. Inclusion criteria for consideration of registry data in national survival analyses are less than 15% of death certificate only (DCO) cases and plausible survival for patients with pancreatic cancer or metastatic lung cancer. Of the 477,300 incident cancer cases estimated for 2010, 429,900 were reported by the cancer registries (90%), and ten federal states contributed data to national survival estimates.

Proceedings of the International Workshop ‘From Global Burden of Disease Studies to National Burden of Disease Surveillance'

Table of contentsI1 Introduction and aims of the workshop Christa Scheidt-Nave, Thomas Ziese, Judith Fuchs, Dietrich PlassS1 History, concept, and current results of GBD for GermanyTom Achoki, Katherine Leach-Kemon, Peter Speyer, William E. Heisel, Emmanuela Gakidou, Theo VosS2 Methodology of the GBD 2013 Study–Mortality, Morbidity, Risk-FactorsMohammad Hossein ForouzanfarS3 National burden of disease surveillance examples of good practice: the case of Public Health EnglandJürgen C. SchmidtS4 Critical aspects of the burden of disease methodology and country-specific challengesClaudia E. SteinS5 Non-communicable disease surveillance in Germany – public health and data challengesChrista Scheidt-Nave, Elena von der Lippe, Benjamin Barnes, Markus Busch, Nina Buttmann-Schweiger, Judith Fuchs, Christin Heidemann, Klaus Kraywinkel, Enno Nowossadeck, Thomas ZieseS6 Different approaches in estimating the burden of communicable diseases using the examples of the healthcare associated infections and influenzaUdo Buchholz, Matthias an der Heiden, Tim Eckmanns, Sebastian HallerS7 Behavioral and environmental attributable risk estimationMohammad Hossein ForouzanfarS8 Environmental Burden of Disease (EBD) in Germany – past achievements and future perspectivesDietrich Plass, Myriam Tobollik, Dagmar Kallweit, Dirk WintermeyerC1 Conclusions of the workshopChrista Scheidt-Nave, Thomas Ziese, Judith Fuchs, Dietrich Plass