Freya Trautmann

A systematic review of the outcomes reported in multimodal pain therapy for chronic pain

There are no recommendations provided for the outcome domains of chronic pain that should be explicitly considered in each clinical trial to describe the efficacy and effectiveness of multimodal pain therapy (MPT). Our aims were to summarize all reported outcome domains in studies assessing the effects of MPT for chronic pain, and to subsequently inform a consensus‐based development of a core outcome set of domains in this field.

Burden of soft-tissue and bone sarcoma in routine care: Estimation of incidence, prevalence and survival for health services research.

BACKGROUND Sarcomas constitute a rare group of malignant tumors which can originate from any organ, tissue, bone or cartilage. Due to their heterogeneity, estimates of sarcoma incidence, prevalence and survival are rare. We estimated the burden of sarcoma in Germany from a large unselected cohort of patients from routine healthcare. METHODS We utilized the AOK PLUS health services research database covering complete medical information on 2,615,865 individuals from the German federal state of Saxony from 2005 to 2012. Persons were defined as sarcoma cases if they had ≥4 medical accounts with respective ICD-10 code C49 (soft-tissue sarcoma) or C40/C41 (bone sarcoma). We assessed sarcoma burden by calculating five-year prevalences, cumulative incidences, and one- and five-year relative survival rates. RESULTS Overall 1,468 persons with soft-tissue sarcoma and 671 persons with bone sarcoma were identified. Age-standardized cumulative incidence was 4.5/100,000 persons for soft-tissue and 2.1/100,000 persons for bone sarcoma (European Standard). One- and five-year relative survival was 87.8% and 66.4% for soft-tissue and 91.8% and 52.9% for bone sarcoma, respectively. CONCLUSION This is the first estimation of the burden of sarcoma based on an unselected sample of routine care data and the first estimation of the burden of sarcoma in Germany. We believe that the proposed methods offer a valuable approach for further outcomes research on cancer.

Effects of the German skin cancer screening programme on melanoma incidence and indicators of disease severity.

In Germany a nationwide melanoma screening programme for adults aged ≥ 35 years was introduced in July 2008. Evidence on utilization and effects is limited.

Einsatz und Wirksamkeit von Systemtherapien bei Erwachsenen mit schwerer Neurodermitis: Erste Ergebnisse des deutschen Neurodermitis‐Registers TREATgermany

Versorgungsregister dienen der Erfassung des Einsatzes und der Wirksamkeit von Therapien unter realen Versorgungsbedingungen und sind als Basis einer evidenzbasierten Gesundheitsversorgung unverzichtbar.

Is ultraviolet exposure acquired at work the most important risk factor for cutaneous squamous cell carcinoma? Results of the population-based case-control study FB-181

Squamous cell carcinoma (SCC) is one of the most frequent types of cancer constituting a significant public health burden. Prevention strategies focus on limiting ultraviolet (UV) exposure during leisure time. However, the relative impact of occupational and nonoccupational UV exposure for SCC occurrence is unclear.

Myelodysplastic syndromes and bone loss in mice and men

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Usage and effectiveness of systemic treatments in adults with severe atopic eczema: First results of the German Atopic Eczema Registry TREATgermany: Systemic treatment of severe atopic dermatitis - TREATgermany

The goal of clinical registries is to document the use and effectiveness of therapeutic interventions under real‐life conditions. They are an indispensable prerequisite of evidence‐based health care.

Patients with soft tissue sarcoma comprise a higher probability of comorbidities than cancer-free individuals. A secondary data analysis

&NA; Soft tissue sarcoma comprises a heterogeneous group of solid malignant tumours. Comorbidities are important prognostic factors for survival and adversely impact quality of life. We examined the complex relationship between soft tissue sarcoma and comorbidities over time in a large population‐based sample. The study uses routine data from the German statutory healthcare system (n = 2,615,865). Case identification of soft tissue sarcoma and comorbid diseases was based on ICD‐10 codes and diagnostic modifiers. Uni‐ and multivariate regression models were used to obtain risk estimates for chronic somatic and mental comorbidities in soft tissue sarcoma patients compared to a cancer‐free control group. At diagnosis, patients with soft tissue sarcoma were significantly more likely to be affected with prevalent bronchial asthma, ≥1 cardiovascular risk factor (hypertension, angina pectoris, heart failure, peripheral arterial disease and thrombosis), back pain, depression, anxiety disorder and adjustment disorder than cancer‐free controls. During the course of disease, sarcoma patients were at a significantly higher risk to develop incident depression, anxiety disorder and adjustment disorder. Comorbidities need to be considered in clinical decision making regarding the treatment of soft tissue sarcoma patients. Psycho‐oncological treatment should be incorporated into medical care of patients with sarcoma.

Associations of myeloid hematological diseases of the elderly with Osteoporosis: A longitudinal analysis of routine health care data

BACKGROUND Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukemia (AML) are hematological stem cell diseases mainly of the elderly. Studies indicate a close relationship between bone metabolism and hematopoietic stem cells within the osteo-hematopoietic niche. However, it remains unclear how the disturbed interaction within the osteo-hematopoietic niche affects bone homeostasis in MDS and AML patients. METHODS We utilized data of a large German statutory health insurance of approximately 2 million persons living in the German federal state of Saxony. Applying case definitions based on diagnosis, procedures and prescriptions we identified prevalent and incident cases with MDS, AML and osteoporosis (OSP) in persons aged ≥60 years. We applied time-to-event analyses to determine the relationship of MDS and AML with OSP with a specific focus on temporality. RESULTS Among all individuals aged ≥60 years (n = 891,095), 2.62% (n = 23,326), 0.14% (n = 1219) and 0.10% (n = 893) were identified with incident OSP, MDS and AML, respectively. The risk of incident OSP was significantly increased in patients with prevalent MDS (sex and age-adjusted model: HR = 1.87, 95%CI: 1.51-2.23). Conversely, patients with prevalent OSP had an increased risk to be diagnosed with incident MDS in the adjusted model (HR = 1.42, 1.19-1.65). For AML no significant associations were observed (adjusted models: inc. OSP with pre. AML; HR = 1.06, 0.65-1.47; inc. AML with pre. OSP; HR = 0.82, 0.41-1.23). DISCUSSION Our results could indicate a clinically relevant relationship between MDS and OSP in elderly patients, most likely resulting from a disturbed microenvironment within the osteo-hematopoietic niche. An alternative, non-causal explanation that MDS is caused by the medication prescribed for OSP can be partially ruled out, as the association between the two diseases remains if incident OSP cases are considered in patients with pre-existing MDS. These results need to be confirmed within other prospective studies and may allow then for comprehensive strategies for the prevention, early detection and clinical care of patients with MDS and OSP.

Response to Ruan et al., EJP 2016.

We would like to thank Ruan et al. (2016) for highlighting the increasingly important political issue related to the discussion on effectiveness and efficacy of multimodal pain therapy (MPT) on the basis of the systematic review on outcomes in MPT by Deckert et al. (2016). We observe with concerns the current development of MPT programmes in the United States, as they were the cradle of this innovative therapeutic approach. The concept of functional restoration – one of several realizations of a biopsychosocial programme on treating chronic pain – has significantly influenced the concept of interdisciplinary multimodal pain therapy in Germany (Kaiser et al., 2015a). Now, after several decades of experience in this field we are facing political struggles. We are also challenged by criteria concerning a superficial understanding of cost effectiveness while losing a comprehensive understanding of effectiveness, for example, considering patients who are satisfied with their results or subsequent costs resulting from an insufficient therapy intervention. Comprehensive therapy programmes such as MPT are certainly cost intensive, but comprehension is necessary to overcome the burden of complex conditions such as chronic pain. Not only for Germany but also for other countries, health care restrictions as reported by Ruan et al. and some others are major obstacles. Other difficult issues are the lack of a consistent and consented definition of MPT (synonymously applied for multidisciplinary, interdisciplinary, comprehensive therapy approaches) clearly indicating aims, conceptual framework and obligatory professions involved as well as the lack of a core outcome set to identify reliable therapy effects and to distinguish them from random and concomitant effects (Kaiser et al., 2015b). Furthermore, we need to develop quality indicators for an effective MPT including the perspective of the patients themselves. Without having solved these problems, a scientific evaluation of MPT will remain difficult or be even impossible. Fortunately, the German health care system covers the costs for MPT in Germany so far, but an increasing number of facilities providing therapies accounting for MPT without realizing the requirements as defined by the German task force on MPT. This may lead to a rising number of patients not being satisfied, increasing costs and therefore decreasing acceptance of MPT among the various stakeholders in the health insurance system. This development might endanger the existence of MPT in Germany as well. Under the auspice of the German IASP chapter, counteracts to this trend are the development of a nationwide accepted definition of MPT, the definition of structure and process quality indicators for pain management facilities (Sabatowski et al., 2011), the description of process quality indicators in MPT as well as the implementation of a structured assessment process before starting MPT. One of the next steps will include the provision of verifiable indicators of MPT programmes, who are fulfilling the high standards as defined by the task force, to politicians and payers. The discussion on MPT and its position in the treatment of patients with chronic pain should not only be held exclusively within the medical society. An openminded discussion including all stakeholders being involved, such as politicians, health care providers, payers and patient representatives, is required. Furthermore, an international discussion has to be initiated, as MPT providers all over the world are seemingly facing more or less the same problems. We would like to thank Ruan et al. for starting this important discussion in the European Journal of Pain.