-
Diana Steinmann,
Yvonne Paelecke-Habermann,
Hans Geinitz,
Raimund Aschoff,
Anja Bayerl,
Tobias Bölling,
Elisabeth Bosch,
Frank Bruns,
Ute Eichenseder-Seiss,
Johanna Gerstein, [......],
Irmgard Kleff,
Axel Müller,
Christof Schäfer,
Ursula Schleicher,
Susanne Sehlen,
Marilena Theodorou,
Hans-Joachim Wypior,
Franz Zehentmayr,
Birgitt van Oorschot, Dirk Vordermark
[show abstract]
[hide abstract]
ABSTRACT: Recently published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases. This prospective multi-center QoL study of patients with brain metastases was designed to investigate which QoL domains improve or worsen after palliative radiotherapy and which might provide prognostic information.
From 01/2007-01/2009, n=151 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. Most patients (82 %) received whole-brain radiotherapy. QoL was measured with the EORTC-QLQ-C15-PAL and brain module BN20 before the start of radiotherapy and after 3 months.
At 3 months, 88/142 (62 %) survived. Nine patients were not able to be followed up. 62 patients (70.5 % of 3-month survivors) completed the second set of questionnaires. Three months after the start of radiotherapy QoL deteriorated significantly in the areas of global QoL, physical function, fatigue, nausea, pain, appetite loss, hair loss, drowsiness, motor dysfunction, communication deficit and weakness of legs. Although the use of corticosteroid at 3 months could be reduced compared to pre-treatment (63 % vs. 37 %), the score for headaches remained stable. Initial QoL at the start of treatment was better in those alive than in those deceased at 3 months, significantly for physical function, motor dysfunction and the symptom scales fatigue, pain, appetite loss and weakness of legs. In a multivariate model, lower Karnofsky performance score, higher age and higher pain ratings before radiotherapy were prognostic of 3-month survival.
Moderate deterioration in several QoL domains was predominantly observed three months after start of palliative radiotherapy for brain metastases. Future studies will need to address the individual subjective benefit or burden from such treatment. Baseline QoL scores before palliative radiotherapy for brain metastases may contain prognostic information.
BMC Cancer 07/2012; 12:283. · 3.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background:
The internet as a source of medical information has emerged during the last years. There is a confusing amount of medical
websites with a great diversity of quality. Websites of radiotherapy institutions could offer a safe and an easy-to-control
way to assist patients’ requests.
Material and Methods:
205 internet appearances of German radiotherapy institutions were analyzed in June 2009 (nonuniversity hospitals n = 108,
medical practices n = 62, university hospitals n = 35). For the evaluation of each homepage verifiable criteria concerning
basic information, service and medical issues were used.
Results:
The quality of information published via internet by different radiotherapy institutions showed a large variety. Basic information
like telephone numbers, operating hours, and direction guidance were provided in 96.7%, 40%, and 50.7%, respectively. 85%
of the websites introduced the staff, 50.2% supplied photos and 14% further information on the attending physicians. The mean
amount of continuative links to other websites was 5.4, the mean amount of articles supplying medical information for patients
summed up to 4.6. Medical practices and university hospitals had statistically significant more informative articles and links
to other websites than nonuniversity hospitals. No statistically significant differences could be found in most other categories
like service issues and basic information.
Conclusion:
Internet presences of radiotherapy institutions hold the chance to supply patients with professional and individualized medical
information. While some websites are already using this opportunity, others show a lack of basic information or of user-friendliness.
Hintergrund:
Das Internet als Quelle für medizinische Informationen hat in den letzten Jahren an Relevanz gewonnen. Es existiert eine unübersichtliche
Anzahl von medizinischen Internetseiten mit großen Qualitätsunterschieden. Webseiten radiotherapeutischer Institute könnten
dabei eine sichere und leicht zu kontrollierende Hilfe für Patienten sein.
Material und Methodik:
Im Juni 2009 wurden 205 Internetauftritte deutscher Strahlentherapieinstitutionen untersucht (nichtuniversitäre Kliniken n
= 108, Praxen n = 62, Universitätskliniken n = 35). Zur Evaluation jeder einzelnen Homepage wurden verifizierbare Kriterien
im Hinblick auf allgemeine Informationen, Serviceaspekte und medizinische Belange untersucht (Tabelle 1).
Ergebnisse:
Die Qualität der Informationen auf den Internetseiten verschiedener radiotherapeutischer Einrichtungen zeigte eine große Bandbreite.
Allgemeine Informationen wie Telefonnummern, Öffnungszeiten und Orientierungshilfen wurden in 96,7%, 40% bzw. 50,7% bereitgestellt.
Auf 85% der Webseiten wurden die Mitarbeiter vorgestellt, 50,2% davon mit Fotos und 14% mit weiterführenden Informationen
zu den behandelnden Ärzten. Die mittlere Anzahl weiterführender Links zu anderen Webseiten betrug 5,4, die mittlere Anzahl
von medizinischen Informationstexten belief sich auf 4,6. Praxen und Universitätskliniken stellten statistisch signifikant
mehr Informationstexte und Links zu anderen Webseiten bereit als nichtuniversitäre Kliniken. Keine statistisch signifikanten
Unterschiede gab es im Servicebereich und bei den allgemeinen Informationen.
Schlussfolgerung:
Internetauftritte radiotherapeutischer Institutionen bieten die Möglichkeit, Patienten mit professionellen und individualisierten
medizinischen Informationen zu versorgen. Während einige Webseiten diese Chance bereits nutzen, weisen andere noch Mängel
im Bereich der allgemeinen Informationen und Benutzerfreundlichkeit auf.
Key WordsWebsites–Internet–Radiotherapy–Patient information
SchlüsselwörterInternetseiten–Internet–Strahlentherapie–Patienteninformation
Strahlentherapie und Onkologie 04/2012; 186(12):700-704. · 3.56 Impact Factor
-
Diana Steinmann,
Christof Schäfer,
Birgitt van Oorschot,
Hans-Joachim Wypior,
Frank Bruns,
Tobias Bölling,
Susanne Sehlen,
Juliane Hagg,
Anja Bayerl,
Hans Geinitz,
Matthias Hipp, Dirk Vordermark
[show abstract]
[hide abstract]
ABSTRACT: Background:
Prospective data on quality-of-life (QoL) effects of radiotherapy for brain metastases are currently lacking, but would be
of great interest to guide therapeutic decisions.
Patients and Methods:
From 01/2007 to 08/2007, 46 patients with previously untreated brain metastases were recruited at eight centers. QoL was measured
at start of treatment (T0) and at 3 months (T3mo). In the pilot study, two combinations of QoL instruments could be used at the discretion of the centers (A: EORTC QLQ-C30
and B: EORTC QLQ-C15-PAL both with brain module BN20, assessment by proxies with A: Palliative Care Outcome Scale, B: self-constructed
brain-specific instrument).
Results:
All patients received whole-brain radiotherapy, four with an additional boost irradiation. At T3mo, 26/46 patients (56.5%) had died. 17/20 survivors (85%) completed the questionnaires. In 3-month survivors, QoL deteriorated
in most domains, significant in drowsiness, hair loss and weakness of legs. The scores for headaches and seizures were slightly
better after 3 months. Assessment by proxies also suggested worsening of QoL. Initial QoL at T0 was better in those alive than in those deceased at T3mo, significant for physical function and for the symptom scales of fatigue and pain, motor dysfunction, communication deficit
and weakness of legs.
Conclusion:
Practicability and compliance appeared better with the (shorter) version B. This version is now used in the ongoing main phase
of the study with additional centers. First results indicate a moderate worsening of QoL during the first 3 months after start
of palliative radiotherapy for brain metastases. QoL at initiation of radiotherapy may be prognostic for survival.
Hintergrund:
Prospektive Daten über die Auswirkung einer palliativen Strahlentherapie auf die Lebensqualität (LQ) von Patienten mit Hirnmetastasen
existieren nur wenige, jedoch sind sie von großem Interesse für Therapieentscheidungen.
Patienten und Methodik:
Von 01/2007 bis 08/2007 wurden an acht Zentren 46 Patienten mit bisher unbehandelten Hirnmetastasen rekrutiert (Tabelle 1).
Die LQ vor und 3 Monate nach palliativer Strahlentherapie wurde erhoben. In der Pilotphase konnten die Zentren zwischen zwei
Kombinationen von Instrumenten wählen (A: EORTC QLQ-C30 und B: QLQ C15-PAL jeweils mit Hirnmodul BN20, Fremdeinschätzung durch
Angehörige mittels A: Palliative Care Outcome Scale, B: eigenen Hirnmoduls).
Ergebnisse:
Alle Patienten erhielten eine Ganzhirnbestrahlung, vier Patienten zusätzlich eine Boostbestrahlung. 3 Monate nach Therapiebeginn
waren 26/46 Patienten (56,5%) verstorben. Die Rücklaufquote der Fragebögen der Überlebenden betrug 17/20 (85%). Für dieses
Kollektiv der 3-Monats-Überlebenden zeigte die Selbsteinschätzung eine Verschlechterung in den meisten Bereichen, signifikant
für Schläfrigkeit, Alopezie und Beinschwäche. Die Scores für Kopfschmerzen und Krampfleiden waren nach 3 Monaten etwas besser
(Abbildung 1). Die Fremdeinschätzungen zeigten ebenfalls eine zunehmende Beeinträchtigung der Patienten nach 3 Monaten (Abbildung
2). Die initiale LQ war bei den 3-Monats-Überlebenden (Abbildung 3a) im Vergleich zu den Verstorbenen besser, signifikant
für die körperliche Funktion und für die Symptomskalen Fatigue, Schmerz (Abbildung 3b), motorische Dysfunktion, Kommunikationsdefizit
und Beinschwäche (Abbildung 3c).
Schlussfolgerung:
Die kürzere Fragebogenvariante B schien bezüglich der Praktikabilität und Compliance besser zu sein. Demzufolge wird diese
Variante in der aktuell laufenden Hauptphase mit zusätzlichen Zentren verwendet (Abbildung 4). Erste Ergebnisse deuten auf
eine mäßige LQ-Verschlechterung bei 3-Monats-Überlebenden hin. Möglicherweise könnte die initiale objektivierte LQ als prädiktiver
Faktor herangezogen werden.
Strahlentherapie und Onkologie 04/2012; 185(3):190-197. · 3.56 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: the internet as a source of medical information has emerged during the last years. There is a confusing amount of medical websites with a great diversity of quality. Websites of radiotherapy institutions could offer a safe and an easy-to-control way to assist patients' requests.
205 internet appearances of German radiotherapy institutions were analyzed in June 2009 (nonuniversity hospitals n = 108, medical practices n = 62, university hospitals n = 35). For the evaluation of each homepage verifiable criteria concerning basic information, service and medical issues were used.
the quality of information published via internet by different radiotherapy institutions showed a large variety. Basic information like telephone numbers, operating hours, and direction guidance were provided in 96.7%, 40%, and 50.7%, respectively. 85% of the websites introduced the staff, 50.2% supplied photos and 14% further information on the attending physicians. The mean amount of continuative links to other websites was 5.4, the mean amount of articles supplying medical information for patients summed up to 4.6. Medical practices and university hospitals had statistically significant more informative articles and links to other websites than nonuniversity hospitals. No statistically significant differences could be found in most other categories like service issues and basic information.
internet presences of radiotherapy institutions hold the chance to supply patients with professional and individualized medical information. While some websites are already using this opportunity, others show a lack of basic information or of user-friendliness.
Strahlentherapie und Onkologie 12/2010; 186(12):700-4. · 3.56 Impact Factor
-
Diana Steinmann,
Christof Schäfer,
Birgitt van Oorschot,
Hans-Joachim Wypior,
Frank Bruns,
Tobias Bölling,
Susanne Sehlen,
Juliane Hagg,
Anja Bayerl,
Hans Geinitz,
Matthias Hipp, Dirk Vordermark
[show abstract]
[hide abstract]
ABSTRACT: Prospective data on quality-of-life (QoL) effects of radiotherapy for brain metastases are currently lacking, but would be of great interest to guide therapeutic decisions.
From 01/2007 to 08/2007, 46 patients with previously untreated brain metastases were recruited at eight centers. QoL was measured at start of treatment (T(0)) and at 3 months (T(3mo)). In the pilot study, two combinations of QoL instruments could be used at the discretion of the centers (A: EORTC QLQ-C30 and B: EORTC QLQ-C15-PAL both with brain module BN20, assessment by proxies with A: Palliative Care Outcome Scale, B: self-constructed brain-specific instrument).
All patients received whole-brain radiotherapy, four with an additional boost irradiation. At T(3mo), 26/46 patients (56.5%) had died. 17/20 survivors (85%) completed the questionnaires. In 3-month survivors, QoL deteriorated in most domains, significant in drowsiness, hair loss and weakness of legs. The scores for headaches and seizures were slightly better after 3 months. Assessment by proxies also suggested worsening of QoL. Initial QoL at T(0) was better in those alive than in those deceased at T(3mo), significant for physical function and for the symptom scales of fatigue and pain, motor dysfunction, communication deficit and weakness of legs.
Practicability and compliance appeared better with the (shorter) version B. This version is now used in the ongoing main phase of the study with additional centers. First results indicate a moderate worsening of QoL during the first 3 months after start of palliative radiotherapy for brain metastases. QoL at initiation of radiotherapy may be prognostic for survival.
Strahlentherapie und Onkologie 04/2009; 185(3):190-7. · 3.56 Impact Factor
-
Susanne Sehlen, Dirk Vordermark,
Christof Schäfer,
Peter Herschbach,
Anja Bayerl,
Steffi Pigorsch,
Jutta Rittweger,
Claudia Dormin,
Tobias Bölling,
Hans Joachim Wypior,
Franz Zehentmayr,
Wolfgang Schulze,
Hans Geinitz
[show abstract]
[hide abstract]
ABSTRACT: Ongoing changes in cancer care cause an increase in the complexity of cases which is characterized by modern treatment techniques and a higher demand for patient information about the underlying disease and therapeutic options. At the same time, the restructuring of health services and reduced funding have led to the downsizing of hospital care services. These trends strongly influence the workplace environment and are a potential source of stress and burnout among professionals working in radiotherapy.
A postal survey was sent to members of the workgroup "Quality of Life" which is part of DEGRO (German Society for Radiooncology). Thus far, 11 departments have answered the survey. 406 (76.1%) out of 534 cancer care workers (23% physicians, 35% radiographers, 31% nurses, 11% physicists) from 8 university hospitals and 3 general hospitals completed the FBAS form (Stress Questionnaire of Physicians and Nurses; 42 items, 7 scales), and a self-designed questionnaire regarding work situation and one question on global job satisfaction. Furthermore, the participants could make voluntary suggestions about how to improve their situation.
Nurses and physicians showed the highest level of job stress (total score 2.2 and 2.1). The greatest source of job stress (physicians, nurses and radiographers) stemmed from structural conditions (e.g. underpayment, ringing of the telephone) a "stress by compassion" (e.g. "long suffering of patients", "patients will be kept alive using all available resources against the conviction of staff"). In multivariate analyses professional group (p < 0.001), working night shifts (p = 0.001), age group (p = 0.012) and free time compensation (p = 0.024) gained significance for total FBAS score. Global job satisfaction was 4.1 on a 9-point scale (from 1 - very satisfied to 9 - not satisfied). Comparing the total stress scores of the hospitals and job groups we found significant differences in nurses (p = 0.005) and physicists (p = 0.042) and a borderline significance in physicians (p = 0.052).In multivariate analyses "professional group" (p = 0.006) and "vocational experience" (p = 0.036) were associated with job satisfaction (cancer care workers with < 2 years of vocational experience having a higher global job satisfaction). The total FBAS score correlated with job satisfaction (Spearman-Rho = 0.40; p < 0.001).
Current workplace environments have a negative impact on stress levels and the satisfaction of radiotherapy staff. Identification and removal of the above-mentioned critical points requires various changes which should lead to the reduction of stress.
Radiation Oncology 02/2009; 4:6. · 2.32 Impact Factor
-
Susanne Sehlen, Dirk Vordermark,
Christof Schäfer,
Peter Herschbach,
Anja Bayerl,
Steffi Pigorsch,
Jutta Rittweger,
Claudia Dormin,
Tobias Bölling,
Hans Wypior,
Franz Zehentmayr,
Wolfgang Schulze,
Hans Geinitz
[show abstract]
[hide abstract]
ABSTRACT: Abstract
Background
Ongoing changes in cancer care cause an increase in the complexity of cases which is characterized by modern treatment techniques and a higher demand for patient information about the underlying disease and therapeutic options. At the same time, the restructuring of health services and reduced funding have led to the downsizing of hospital care services. These trends strongly influence the workplace environment and are a potential source of stress and burnout among professionals working in radiotherapy.
Methods and patients
A postal survey was sent to members of the workgroup "Quality of Life" which is part of DEGRO (German Society for Radiooncology). Thus far, 11 departments have answered the survey. 406 (76.1%) out of 534 cancer care workers (23% physicians, 35% radiographers, 31% nurses, 11% physicists) from 8 university hospitals and 3 general hospitals completed the FBAS form (Stress Questionnaire of Physicians and Nurses; 42 items, 7 scales), and a self-designed questionnaire regarding work situation and one question on global job satisfaction. Furthermore, the participants could make voluntary suggestions about how to improve their situation.
Results
Nurses and physicians showed the highest level of job stress (total score 2.2 and 2.1). The greatest source of job stress (physicians, nurses and radiographers) stemmed from structural conditions (e.g. underpayment, ringing of the telephone) a "stress by compassion" (e.g. "long suffering of patients", "patients will be kept alive using all available resources against the conviction of staff"). In multivariate analyses professional group (p < 0.001), working night shifts (p = 0.001), age group (p = 0.012) and free time compensation (p = 0.024) gained significance for total FBAS score. Global job satisfaction was 4.1 on a 9-point scale (from 1 – very satisfied to 9 – not satisfied). Comparing the total stress scores of the hospitals and job groups we found significant differences in nurses (p = 0.005) and physicists (p = 0.042) and a borderline significance in physicians (p = 0.052).
In multivariate analyses "professional group" (p = 0.006) and "vocational experience" (p = 0.036) were associated with job satisfaction (cancer care workers with < 2 years of vocational experience having a higher global job satisfaction). The total FBAS score correlated with job satisfaction (Spearman-Rho = 0.40; p < 0.001).
Conclusion
Current workplace environments have a negative impact on stress levels and the satisfaction of radiotherapy staff. Identification and removal of the above-mentioned critical points requires various changes which should lead to the reduction of stress.
Radiation Oncology. 01/2009;
