Ulf Seifart

TNF-α, TNF-β, IL-6, and IL-10 Polymorphisms in Patients with Lung Cancer

Apart from cigarette smoking, genetic factors seem to be of importance in the development of lung cancer. The present case-control study investigated frequencies of five inflammatory response gene polymorphisms (TNF-α-308, TNF-β-Intron1-252, IL-6-174, IL-10-819 and IL-10-1082) in patients with lung cancer and controls. The study population consisted of 117 patients with lung cancer (77 patients with NSCLC, including 40 Squamous Cell Carcinoma and 26 Adenocarcinoma, and 40 patients with SCLC), 117 matched controls without pulmonary disease and 243 healthy individuals (population control). Genotype analyses revealed no difference in genotype frequencies using matched-pair analysis. However, in comparison to the population control, the IL-10-1082 genotypes carrying the G allele appeared with higher frequency in the SCLC group (p = 0.006) [SCLC: 84.6%, population controls: 64.6%]. This yields an odds ratio of 3.01 for SCLC (95% CI = [1.21, 7.48]). No associations were seen for all other polymorphisms analysed. The study raises the possibility of a correlation between the IL-10-1082_G allele and the presence of SCLC in a German population. The functional IL-10-1082 polymorphism correlates with altered IL-10 levels and might influence lung cancer susceptibility by altered inflammatory responses in the airways.

Chronic eosinophilic leukaemia (CEL): a distinct myeloproliferative disease

Chronic eosinophilic leukaemia has not yet been clearly defined, mainly due to the fact that it has not been conclusively shown as a monoclonal disease which should be separated from chronic myelogenous leukaemia, acute myelogenous leukaemia with eosinophilia (AML, FAB M4Eo), and the idiopathic hypereosinophilic syndrome.

Rare SP-A alleles and the SP-A1-6A4 allele associate with risk for lung carcinoma

Next to cigarette smoking, genetic factors may contribute to lung cancer risk. Pulmonary surfactant components may mediate response to inhaled carcinogenic substances and/or play a role in lung function and inflammation. We studied associations between surfactant protein (SP) genetic variants and risk in lung cancer subgroups. Samples (n = 308) were genotyped for SP‐A1, ‐A2, ‐B, and ‐D marker alleles. These included 99 patients with small cell lung carcinoma (SCLC, n = 31), or non‐SCLC (NSCLC, n = 68) consisting of squamous cell carcinoma (SCC, n = 35), and adenocarcinoma (AC) (n = 23); controls (n = 99) matched by age, sex, and smoking status (clinical control) to SCLC and NSCLC; and 110 healthy individuals (population control). We found (a) no significant marker associations with SCLC, (b) rare SP‐A2 (1A9) and SP‐A1 (6A11) alleles associate with NSCLC risk when compared with population control, (c) the same alleles (1A9, 6A11) associate with risk for AC when compared with population (6A11) or clinical control (1A9), and (d) the SP‐A1‐6A4 allele (found in approximately 10% of the population) associates with SCC, when compared with population or clinical control. A correlation between SP‐A variants and lung cancer susceptibility appears to exist, indicating that SP‐A alleles may be useful markers of lung cancer risk.

Surfactant protein B gene variations enhance susceptibility to squamous cell carcinoma of the lung in German patients

Genetic factors are thought to influence the risk for lung cancer. Since pulmonary surfactant mediates the response to inhaled carcinogenic substances, candidate genes may be among those coding for pulmonary surfactant proteins. In the present matched case–control study a polymorphism within intron 4 of the gene coding for surfactant specific protein B was analysed in 357 individuals. They were divided into 117 patients with lung cancer (40 patients with small cell lung cancer, 77 patients with non small cell lung cancer), matched controls and 123 healthy individuals. Surfactant protein B gene variants were analysed using specific PCR and cloned surfactant protein B sequences as controls. The frequency of the intron 4 variation was similar in both control groups (13.0% and 9.4%), whereas it was increased in the small cell lung cancer group (17.5%) and the non small cell lung cancer group (16.9%). The gene variation was found significantly more frequently in patients with squamous cell carcinoma (25.0%, P=0.016, odds ratio=3.2, 95%CI=1.24–8.28) than in the controls. These results indicate an association of the surfactant protein B intron 4 variants and/or its flanking loci with mechanisms that may enhance lung cancer susceptibility, especially to squamous cell carcinoma of the lung.

Berufliche Wiedereingliederung nach einer Krebsbehandlung

Eine Krebserkrankung und ihre Therapie haben erhebliche körperliche, psychische und soziale Folgen. Diese können sich auch negativ auf den beruflichen Wiedereinstieg auswirken. Ziel der Rehabilitation ist es, die Belastbarkeit der Patienten mithilfe eines multimodalen Konzepts zu fördern, um den Wiedereinstieg zu erleichtern.

P-108 Do family members of palliative patients want to talk different about end of life decisions?

Background Little is known about potential different preferences between patients and their family members concerning content and timing of end of life decisions (EOLD) discussions. Aim To gain more information about patients and their family members desires for EOLD discussion. Methods We conducted a semi-structured interview with 89 palliative cancer patients and 68 of their family members. We asked them to rate the importance of six main topics (scale 1–10) and to choose their preferred timing (scale 1–3). Differences were analysed using the Mann-Whitney test. Results In both groups “medical care” seemed to be the main topic, particularly for family members (M = 9,21, SD ±1,33; z = –2,86; p < 0.05; r = 0.004). “Nursing care” also appeared to be an important issue, but in contrast to the importance, it was chosen at a very late date as a topic of desired conversation. Family members chose “feelings” as a hot topic at a very early point in time (M = 1,42, SD ±0,79), in comparison to the patients (z = –2,71; p < 0.05; r = 0.007). They also showed significantly more interest in this topic (z = –1,98; p < 0.05; r = 0.047). Conclusion The difference between the two groups in content and timing of conversations was larger than previously expected. “Medical care” and “nursing care” seem to be important for both groups, but while “medical care” should be discussed earlier, it seems that “nursing care” is only a topic of interest, when the general condition deteriorated. Interestingly, the topic “feelings” differed significantly between both groups and should be considered in EOLD discussions with family members.

O-57 Talking about death – should it be obligatory?

Background Although the benefits of Advance Care Planning (ACP) and of communication about End-Of-Life-Decisions (EOL-D) appear significant and conclusive, widespread adaptation is still lacking. A number of reasons for this have been discussed, including patients’ apparent refusal to talk about the end of their life. Aim To examine whether there is an ethical obligation for physicians to lead conversations about EOL-D – even if some patients do not wish to talk. Methods Initially, we extracted items concerning 254 cancer patients’ desire for, experience of and acting upon autonomy from our study „Advance Care Planning – Conversations about End-of-Life Decisions”. We subsequently analysed these findings from a bioethical point of view. Results We found significant discrepancy between self-reported desire for autonomy in patients and the concurrent non-exercising of instruments of (anticipated) autonomy. Discussion Such apparent contradiction between desire for autonomy and non-exercising of its possibilities could be deemed un-authentic under the conditions of “personal autonomy”. This might prima facie justify obligatory conversations about EOL-D for the sake of a patient’s real volition – a highly questionable proposal in severable respects. Conclusion To solve this dilemma, we need to analyse the concept of “personal autonomy” further and apply the idea of “having a right to ignorance” and the approaches towards other seemingly “irrational” patient’s decisions on the given situation. We conclude that a physician’s obligation canindeed be put up here, but it is distinctly different from the one in question. This way we can come to a solution which likewise respects autonomy and beneficence.