Jutta Hübner

Malignant Melanoma S3-Guideline "Diagnosis, Therapy and Follow-up of Melanoma"

This first German evidence-based guideline for cutaneous melanoma was developed under the auspices of the German Dermatological Society (DDG) and the Dermatologic Cooperative Oncology Group (DeCOG) and funded by the German Guideline Program in Oncology. The recommendations are based on a systematic literature search, and on the consensus of 32 medical societies, working groups and patient representatives. This guideline contains recommendations concerning diagnosis, therapy and follow-up of melanoma. The diagnosis of primary melanoma based on clinical features and dermoscopic criteria. It is confirmed by histopathologic examination after complete excision with a small margin. For the staging of melanoma, the AJCC classification of 2009 is used. The definitive excision margins are 0.5 cm for in situ melanomas, 1 cm for melanomas with up to 2 mm tumor thickness and 2 cm for thicker melanomas, they are reached in a secondary excision. From 1 mm tumor thickness, sentinel lymph node biopsy is recommended. For stages II and III, adjuvant therapy with interferon-alpha should be considered after careful analysis of the benefits and possible risks. In the stage of locoregional metastasis surgical treatment with complete lymphadenectomy is the treatment of choice. In the presence of distant metastasis mutational screening should be performed for BRAF mutation, and eventually for CKIT and NRAS mutations. In the presence of mutations in case of inoperable metastases targeted therapies should be applied. Furthermore, in addition to standard chemotherapies, new immunotherapies such as the CTLA-4 antibody ipilimumab are available. Regular follow-up examinations are recommended for a period of 10 years, with an intensified schedule for the first three years.

What Cancer Patients Find in the Internet: The Visibility of Evidence-Based Patient Information - Analysis of Information on German Websites

Background: The internet is an easy and always accessible source of information for cancer patients. The aim of our study was to evaluate the information provided on German websites. Material and Methods: We developed an instrument based on criteria for patient information from the German Network for Evidence-based Medicine, the Agency for Quality in Medicine, HONcode, DISCERN, and the afgis. We simulated a patients search and derived the websites for evaluation. We analyzed the visibility of each website and evaluated the websites using the developed instrument. Results: We analyzed 77 websites. The highest visibility index was shown by 4 profit websites. Websites from professional societies and self-help groups have low rankings. Concerning quality, websites from non-profit providers and self-help groups are on top. Websites with a profit interest have the lowest average score. Conclusions: A discrepancy exists between the visibility and the quality of the analyzed websites. With the internet becoming an important source of information on cancer treatments for patients, this may lead to false information and wrong decisions. We provide a list of suggestions as to how this risk may be reduced by complementary information from the physician and from trustworthy websites.

Survey of Students Regarding Their Attitudes toward Complementary and Alternative Medicine in Oncology

Dr. med. Jutta HubnerLeiterin Palliativmedizin, supportive und komplementare OnkologieKlinikum der Johann Wolfgang Goethe-UniversitatTheodor-Stern-Kai 7, 60590 Frankfurt, Germanyhuebner@med.uni-frankfurt.de© 2012 S. Karger GmbH, Freiburg1661-4119/12/0196-0319

Vorstellungen zur Therapie von Malignomen mit Krebsdiäten

38.00/0Accessible online at: www.karger.com/fokFax +49 761 4 52 07 14Information@Karger.dewww.karger.com

So beraten Sie Ihre Patienten: Komplementärmedizin bei Krebs?

ZusammenfassungHintergrundKrebsdiäten beruhen auf der Vorstellung eines „Mangels“ oder „zu viel“ an Nahrungsbestandteilen, welcher dann zur Tumorgenese führt oder wesentlich beiträgt. Entsprechend werden mit der Diät diese Substanzen nicht mehr zugeführt (der Tumor ausgehungert) oder der Mangel ausgeglichen.MethodeDie in diesem Beitrag vorgestellten Krebsdiäten wurden mithilfe von Literaturrecherchen und der ESPEN-Leitlinie auf ihre Eignung für Tumorpatienten überprüft.ErgebnisseDie laienhaften Vorstellungen stimmen mit wissenschaftlichen Daten zur Kanzerogenese nicht überein. Keine der Krebsdiäten (Rohkost, Heilfasten, Krebskur nach Breuß, Budwig-Diät, Gerson-Regime, Makrobiotik und kohlenhydratarme oder ketogene Kost) sind in kontrollierten klinischen Studien belegt worden. Alle Diäten können (in unterschiedlich starkem bzw. schnellen Ausmaß) zu einer Mangelernährung führen.SchlussfolgerungTumorpatienten sollte von diesen Diäten abgeraten werden.AbstractContextDiets against cancer are built on the idea of a deficit or abundance of nutritional components which lead to cancerogenesis. In line with this concept, these components are reduced (starving of the tumor) or the deficit is corrected.MethodWe evaluated the cancer diets described in this article according to their usefulness for cancer patients searching the literature and comparing them to the ESPEN guidelines.ResultsThis lay concept is not in accordance with scientific data on cancerogenesis. None of the cancer diets (e.g. raw cost, fasting for cure, cancer cure total of Breuss, Budwig diet, Gerson’s regimen macrobiotic and low carbohydrate or ketogenic diet) have been proven in controlled clinical trials. They can all lead to malnutrition (to different extents in severity and time).ConclusionTumor patients should be advised by physicians not to undertake these diets.

Analysis of the Contents of German Magazines for Tumor Patients

„Pflanzliche Praparate bei Krebs – das bringt doch eh nichts!“ Wer seine Patienten so abschmettert, der vergibt die Chance auf eine gute Arzt-Patienten-Beziehung. Denn viele Krebspatienten wollen ihre Heilung selbst vorantreiben und wenden sich im Vertrauen an ihren Arzt. Ein respektvoller und wertschatzender Umgang sowie eine gute Aufklarung konnen dieses Vertrauensverhaltnis starken.

Kritische Analyse der Internetseiten der Gesellschaft für Biologische Krebsabwehr

Background: Cancer patients have high information needs. Besides direct discussion with the physician, media provide important access to information. In the age of the internet, print media are still being used by many patients. In Germany, several magazines for cancer patients are distributed at no cost to cancer institutions for display. The aim of our study was to assess the content of these magazines. Methods: In a first step, a search of the literature concerning patient information needs and evaluation of patient information was done. This search revealed important criteria for evaluation. 2 instruments are recognized internationally as appropriate in evaluating and certifying patient information: HONcode and DISCERN. As we did not find an instrument for the evaluation of patient magazines, we combined the central items from both instruments. With this new instrument, we assessed the 2010 issues of all 5 magazines . Results: The Krebsmagazin offers a vast range of different topics in cancer and thus aims at general patient education, irrespective of the level of knowledge. Befund Krebs offers a wider variety of topics in each issue. Understanding the articles requires basic knowledge. The same applies to Leben? Leben! which specifically addresses the topic of breast cancer. All 3 journals provide information in line with evidence-based medicine. K Journal - Mensch & Krebs provides information on conventional as well as alternative treatments, the latter not being evidence-based. Several issues contained both advertisements and articles by providers of alternative therapies. Signal only deals with alternative medicine in cancer care and does not provide scientifically proven data. Conclusion: As our analysis shows, content and evidence vary greatly in the magazines currently distributed in Germany. Physicians should familiarize themselves with the characteristics of the different journals before recommending them.

Update komplementäre Onkologie 2012

ZusammenfassungDie Gesellschaft für biologische Krebsabwehr hat in der Beratung von Patienten mit Tumorerkrankungen in Bezug auf Verfahren der Komplementär- und Alternativmedizin eine hohe Bedeutung. Entgegen dem Anspruch, Patienten in ihrer autonomen Entscheidung zu unterstützen, wofür eine objektive und ausgewogene Darstellung der Sachverhalte erforderlich wäre, werden Methoden der konventionellen Medizin als wenig effektiv, aber nebenwirkungsreich dargestellt. Dagegen werden Methoden der unkonventionellen Therapie positiv dargestellt. Mehrfach werden Empfehlungen entgegen den Leitlinien und Empfehlungen der Fachgesellschaften ausgesprochen. Dies erschwert den Dialog zwischen Onkologen und Patient und kann zu einem Verzicht auf oder einer Verzögerung von sinnvollen Therapiemaßnahmen führen. Es fehlt eine klare Abgrenzung von sinnvollen, evidenzbasierten komplementären Methoden und der alternativen Medizin.AbstractThe German Society for Biological Cancer Defence has a strong position in counseling cancer patients concerning methods of complementary and alternative medicine. In spite of the purpose to strengthen patient autonomy for which goal objective information on the disease and treatment options is mandatory, methods of conventional medicine are described as being of low efficacy but with a high potential for side effects. In contrast methods of unconventional therapy are depicted as being positive. In several cases recommendations against guidelines and recommendations of the scientific societies are given. Thus communication between oncologists and patients can become difficult and patients can be led to omit or delay helpful conventional therapy. A clear distinction between evidence-based complementary methods and alternative medicine is missing.

Informationen zur komplementären und alternativen Medizin auf den Internetseiten deutscher Selbsthilfegruppen für Tumorpatienten

ZusammenfassungDer Versuch einer Prävention von Tumorerkrankungen durch Einnahme von Vitaminen und Spurenelementen ist nicht sinnvoll. Mangelzustände wie Vitamin-D- und Selenmangel sollten allerdings gezielt ausgeglichen werden. Verfahren der komplementären Medizin wie Qigong können vielfältige Beschwerden bei Tumorpatienten verbessern. 2011 erschienen eine Reihe klinischer Studien zu Heilpflanzen. Ingwer und Mariendistel (Silymarin) können unterstützend bei Übelkeit bzw. Leberschäden eingesetzt werden. Sie ersetzen ein leitliniengerechtes Vorgehen nicht. Trotz allen Interesses für chinesische Heilkräutermischungen bleiben die Daten wenig überzeugend – negative Wirkungen sind möglich. Die Wirkung von Granatapfel bei Prostatakarzinomen konnte auch klinisch belegt werden.AbstractVitamins and trace elements as supplements do not prevent cancer. Nevertheless, vitamin D and selenium should be substituted if the serum level is below normal. Complementary treatments like Qigong are able to reduce various complaints in cancer patients. In 2011 several clinical studies with different herbs were published. Ginger and milk thistle can be used as supportive drugs against nausea and hepatotoxicity. However, they are no substitute for supportive treatment as specified in guidelines. Despite great interest in Chinese herbs, clinical evidence is not convincing and negative effects are possible. The efficiency of pomegranate against prostate cancer was demonstrated in a clinical study.

Mit richtiger Ernährung gegen therapiebedingte Nebenwirkungen

INTRODUCTION Complementary and alternative medicine (CAM) is important for cancer patients. The internet has a rising relevance of source of health information. Patient set strong confidence in websites from patient advocacy groups. The websites of German patient advocacy groups were analysed regarding information on CAM. METHODS An analysis on the homepages of the most important self-help organizations for cancer patients in Germany was performed. A descriptive analysis of the contents at a cutoff date (20.12.2011) listing the contents was done using an instrument based on the HonCode criteria. RESULTS The homepages of the self-help groups are heterogeneous concerning CAM. Only few sites provide more information. The differences between the self-help groups do not correlate with the known user rate of patients with different kinds of cancer. Most homepages dealing with the topic also point to the associated problems of side effects and interactions. All homepages make a clear difference between information and opinion. Influences from outside were not detected. CONCLUSION In spite of a high number of patients using CAM the topic is only infrequently represented on the homepages. This could be due to difficult and contradictory data on KAM. As websites of patient advocacy are well suited to provide information on CAM the patient version of a S3 guideline in the German national guideline program in oncology could provide a fundament.